Factors associated with postoperative axial symptom after expansive open-door laminoplasty: retrospective study using mu
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ORIGINAL ARTICLE
Factors associated with postoperative axial symptom after expansive open‑door laminoplasty: retrospective study using multivariable analysis Xiuru Zhang1 · Yanzheng Gao1 · Kun Gao1 · Zhenghong Yu1 · Dongbo Lv1 · Hao Ma1 · Gongwei Zhai1 Received: 6 October 2019 / Revised: 30 April 2020 / Accepted: 31 May 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose The aim of the present study was to investigate the factors associated with axial symptom using multivariable analysis. Methods The authors retrospectively assessed 249 patients treated by open-door laminoplasty. The patients were classified into two groups: axial symptom and no axial symptom group. The possible factors included demographic variables (age, sex, BMI, smoking, heart disease, diabetes, preoperative neck pain, preoperative JOA scores, preoperative NDI, course of disease and pathogenesis) and surgical and radiological variables [operation time, intraoperative blood loss, collar wear time, preoperative cervical curvature, postoperative cervical curvature, T1 slope, preoperative and postoperative C2 sagittal vertical axis (C2 SVA)]. Results The prevalence of axial symptom was 34.9% (89/249). The collar wear time, preoperative and postoperative C2 SVA were risk factors for axial symptom. A cutoff value of 22.6 mm for preoperative C2 SVA and 3.5 weeks for collar wear time predicted the development of axial symptom. Conclusions The longer collar wear time, larger preoperative and postoperative C2 SVA were positively correlated with the higher incidence of axial symptom. Keywords Axial symptom · Expansive open-door laminoplasty · C2 sagittal vertical axial · Risk factors
Introduction Expansive open-door laminoplasty (EOLP) has been widely used as posterior cervical surgery. Axial symptom, a wellknown complication after laminoplasty, leads to pain and/ or stiffness around the posterior neck or suprascapular areas and poor quality of life [1, 2]. Postoperative axial symptom could affect the recovery of Japanese Orthopaedic Association (JOA) and Neck Disability Index (NDI). A recent study showed that the change of JOA for 2.5 and NDI for 4.2 among patients undergoing cervical laminoplasty was one of the most important psychometric parameters for assessing the postoperative results of spinal surgery [3]. * Yanzheng Gao [email protected] 1
Department of Surgery of Spine and Spinal Cord, Henan Provincial People’s Hospital; People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou 450003, Henan, China
Therefore, it is very important to reduce the occurrence of axial symptoms after laminoplasty. Causative mechanisms that have been proposed for axial symptom include lamina open-door angles ˃ 30° [4], range of motion [5], less neck muscle strength [6], older age (˃ 63 years) and preservation of muscles attached at the C2 spinous process [7]. The exact risk factors for axial symptom remain unclear. However, multiple factors are likely to be involved. In recent year, cervical sa
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