COMPARATIVE STUDY
JOURNAL ARTICLE

Where should a laminoplasty start? The effect of the proximal level on post-laminoplasty loss of lordosis

Keith W Michael, Thomas M Neustein, John M Rhee
Spine Journal: Official Journal of the North American Spine Society 2016, 16 (6): 737-41
26828011

BACKGROUND CONTEXT: Open-door laminoplasty is a useful operation in the surgical management of cervical myelopathy with favorable outcomes and relatively low complications. One potential undesirable outcome is a decrease in cervical lordosis postoperatively. It is unknown whether the most proximal level undergoing laminoplasty affects the magnitude of loss of lordosis.

PURPOSE: This study aimed to compare the loss of cervical lordosis postoperatively in patients for whom the most proximal level undergoing laminoplasty is C3 versus C4.

STUDY DESIGN/SETTING: A retrospective radiographic review at an academic center was carried out.

PATIENT SAMPLE: A total of 65 patients at a single institution who underwent plated open door laminoplasty for cervical myelopathy by multiple surgeons over a 5-year period were included.

OUTCOME MEASURES: The primary outcome was change in cervical lordosis, which was the difference in C2-T1 Cobb angle between the postoperative and preoperative films.

METHODS: Patients were divided into two groups based on the most proximal vertebral level undergoing laminoplasty. There were 49 patients who underwent laminoplasty beginning at C3, whereas 16 patients underwent laminoplasty beginning at C4. The C2-T1 Cobb angle was measured on the preoperative film and on the final postoperative follow-up film. The difference between these values was calculated for each patient, and the mean of the differences for the C3 group was compared with that of the C4 group.

RESULTS: When C3 was the proximal plated laminoplasty level, loss of lordosis averaged 9°. In contrast, when C4 was the proximal plated level, loss of lordosis was significantly less and averaged only 3° (p=.047). In the group as a whole, mean preoperative lordosis was 18° compared with 11° postoperatively, for an overall 7° loss of lordosis.

CONCLUSIONS: Starting the laminoplasty at C4 led to significantly less loss of lordosis than starting at C3. When the pattern of spinal cord compression does not require laminoplasty at C3, consideration should be given to making C4 the most cephalad laminoplasty level rather than C3 to better preserve lordosis.

Full Text Links

Find Full Text Links for this Article

Discussion

You are not logged in. Sign Up or Log In to join the discussion.

Trending Papers

Remove bar
Read by QxMD icon Read
26828011
×

Save your favorite articles in one place with a free QxMD account.

×

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"

We want to hear from doctors like you!

Take a second to answer a survey question.