Effect of posterior cervical expansive open-door laminoplasty on cervical sagittal balance
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ORIGINAL ARTICLE
Effect of posterior cervical expansive open‑door laminoplasty on cervical sagittal balance Yubo Pan1 · Xun Ma1 · Haoyu Feng1 · Chen Chen1 · Zhiyong Qin1 · Yi Huang1 Received: 9 January 2020 / Accepted: 4 August 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Posterior cervical expansive open-door laminoplasty (LAMP) is a mature surgical procedure for the treatment of cervical spondylotic myelopathy (CSM), but there are few studies on the changes in cervical sagittal balance. This study aimed to analyze the imaging and clinical data of patients who underwent LAMP and to explore the effect of this procedure on the cervical sagittal balance. Methods This was a retrospective study of the patients who underwent LAMP between 01/2014 and 12/2017. The C0–C2 Cobb angle, sagittal vertical angle (SVA), C2–C7 Cobb angle, and T1-slope were measured. The Japanese Orthopaedic Association (JOA) score, neck disability index (NDI), and visual analog scale (VAS) were used. Results There were 69 males and 39 females. The mean age was 61.3 ± 5.3 years. The C0–C2 Cobb angle increased from 11.3 ± 5.5° to 26.8 ± 4.8° (P = 0.186). The C2–C7 Cobb angle decreased from 13.9 ± 8.6° to 10.65 ± 10.7° P = 0.016). SVA increased from 21.0 ± 5.8 mm to 25.4 ± 11.5 mm (P = 0.001). The preoperative average JOA score was 11.1 ± 2.2 points, and the postoperative score was 14.0 ± 2.1 points, with an average improvement rate of JOA of 46.5 ± 3.8%. The NDI score decreased from preoperative 15.6 ± 5.4 points to 11.3 ± 7.9 points, and the VAS score was decreased from 4.6 ± 1.8 points to 3.3 ± 1.6 points (all P 25°, an anterior approach was considered. When the C2–7 SVA was > 40 mm, an anterior approach was also considered. The posterior middle approach was performed to longitudinally cut the skin and subcutaneous tissues in sequence, exposing the deep fascia.
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European Spine Journal
Subperiosteal decollement of the bilateral paraspinal muscles was performed to expose the spinous process, bilateral vertebral plates, and medial part of the articular process. For ease of operation, the right side was selected as the hinge side. The medial margin of the articular process at the bilateral vertebral plates was grooved to remove the cortical bone and part of the cancellous bone, and the inner cortex was retained. At the opening side, the removal was performed to the inner cortex. Two vertebral plate grippers were used to simultaneously grip the vertebral plate edge on the hinge and opening sides. With the hinge side as the fulcrum, the vertebral plate was slowly and gently turned to the hinge side. A periosteal detacher was used for the auxiliary distraction of the opening side along the inner edge of the lateral mass in order to achieve an appropriate opening distance, which was usually 10 mm; the opening angle of the vertebral plate was mostly 40°. Titanium plates of suitable size were separately fixed on the lateral mass and vertebral plate. The position of the titanium plates was adjusted and fixed b
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