Analysis of the risk factors for increasing cervical sagittal vertical axis after cervical laminoplasty for cervical spo
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ORTHOPAEDIC SURGERY
Analysis of the risk factors for increasing cervical sagittal vertical axis after cervical laminoplasty for cervical spondylotic myelopathy Tetsutaro Abe1 · Masashi Miyazaki1 · Toshinobu Ishihara1 · Shozo Kanezaki1 · Naoki Notani1 · Masashi Kataoka2 · Hiroshi Tsumura1 Received: 26 April 2020 / Accepted: 15 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Introduction The cervical sagittal vertical axis (cSVA) as another aspect of cervical alignment been recognized as one of the important factors affecting the pain and disability outcomes of cervical spine surgery. The purpose of the present study was to analyze the risk factors for increasing cSVA after cervical laminoplasty for cervical spondylotic myelopathy (CSM). Materials and methods This retrospective study included 110 consecutive patients (68 males and 42 females, average age 72.6 years) who underwent laminoplasty for CSM between January 2007 and June 2018. We recorded the operative time, blood loss, Japanese Orthopaedic Association (JOA) score and the recovery rate. Radiological measurements were performed to analyze the following parameters: pre- and 1-year postoperative McGregor’s slope (McGS), occiput to C2 Cobb angle (O–C2 angle), C2–C7 Cobb angle (C2–7 angle), T1-slope (T1S), C2–7 SVA (cSVA) and calculated the change (Δ). Patients were divided into two groups according to whether ΔcSVA was positive or negative. We also used Spearman’s correlation coefficient and multiple regression analysis. Results ΔC2–7 angle, ΔT1S—preoperative C2–7 angle, ΔO–C2 angle were different between the two groups significantly. Correlation analysis between the ΔcSVA and the various sagittal parameters showed some independent explanatory factors including the ΔC2–7 angle (r = − 0.25, p = 0.010), T1S—preoperative C2–7 angle (r = − 0.28, p = 0.004), postoperative O–C2 angle (r = 0.26, p = 0.007), ΔO–C2 angle (r = 0.37, p = 0.001). Multiple regression analysis revealed that ΔcSVA was associated with the T1S—preoperative C2–7 angle (β = − 0.25, p = 0.034) and ΔO–C2 angle (β = 0.32, p = 0.001). Conclusions The imbalance between T1S and preoperative C2–7 angle influences the change of cSVA after cervical laminoplasty. If cSVA increases postoperatively, the O–C2 angle increases to compensate and maintain the horizontal gaze. Keywords Cervical spondylotic myelopathy · Cervical spine · Laminoplasty · Myelopathy · Quality of life · Sagittal alignment · Spinal cord compression
Introduction Laminoplasty has been reported to have good results and is widely established as a reliable surgical procedure for cervical spondylotic myelopathy (CSM) [1–3]. Since laminoplasty achieves indirect posterior decompression, it is not suitable for patients with preoperative cervical kyphotic * Masashi Miyazaki masashim@oita‑u.ac.jp 1
Department of Orthopaedic Surgery, Faculty of Medicine, Oita University Hospital, 1‑1 Idaigaoka, Hasama‑machi, Yufu‑shi, Oita 879‑5593, Japan
Physical Therapy Course of Study, Faculty of Welfare and Healt
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