Analysis of the outcome in patients with cervical spondylotic myelopathy, undergone canal expansive laminoplasty supported with instrumentation in a group of Indian population - a prospective study

Laminoplasty Achieves Improved Outcomes Despite Leading to a More Positive Sagittal Balance: Neither Preoperative Nor Postoperative Sagittal Balance Correlated With Spine-specific Outcome Data

STUDY DESIGN

A retrospective study of prospective data.

OBJECTIVE

Determine the correlation between cervical sagittal alignment, either preoperative or postoperative, and the outcomes of laminoplasty.

SUMMARY OF BACKGROUND DATA

Cervical laminoplasty is a common surgical treatment for myelopathy. However, the effect of preoperative or postoperative cervical sagittal alignment on outcomes, such as neurological improvement and patient-reported outcomes, remains unclear.

METHODS

A total of 144 consecutive patients (2007-2017) with laminoplasty for myelopathy and a minimum of 1-year postoperative follow-up were reviewed. The severity of myelopathy was assessed by modified Japanese Orthopedic Association (mJOA) scores. Total pain was measured by the visual analog scale. Patient-reported outcome included neck disability index (NDI) and 12-item short-form survey (SF-12). Radiographic measures of cervical sagittal alignment on x-ray images consisted of C2-C7 angle, T1 slope, C2-C7 sagittal vertical axis (SVA), and C2-C7 forward pitch (FP). Patients were also divided into 2 groups based on the postoperative C2-C7 SVA (≥40 or <40 mm) for outcome comparison.

RESULTS

Laminoplasty yielded improvement in functionality as evidenced by significantly increased mJOA scores, decreased total pain scores, and improved NDI scores at final follow-up. There was a change in sagittal balance postoperatively with significantly increased C2-C7 SVA and FP (7-8 mm increase). However, there was no correlation between preoperative sagittal alignment and outcomes. There was also no correlation between postoperative sagittal alignment and most outcomes, except for a significantly negative correlation between FP and short form-physical component summary (Spearman r=-0.328, P=0.011). When those with postoperative C2-C7 SVA ≥40 mm (n=60) were compared with those with <40 mm (n=84), there was no significant difference in outcomes.

CONCLUSIONS

Cervical laminoplasty yields significant neurological and functional improvement despite a more positive sagittal balance postoperatively, with increased C2-C7 SVA and FP. However, other than a lower short form-physical component summary score, neither preoperative nor postoperative sagittal alignment measures correlated with spine-specific outcomes.

LEVEL OF EVIDENCE

Level II-a retrospective cohort study.

Comparison of single versus double door posterior cervical laminoplasty for patients with cervical spondylotic myelopathy: A systematic review and meta-analysis

OBJECTIVE

We undertook a meta-analysis to compare the efficacy and safety of single versus double door posterior cervical laminoplasty for cervical spondylotic myelopathy.

METHODS

PubMed, Embase, and Cochrane Central Register of controlled trials were searched for randomized controlled trials investigating single and double door posterior cervical laminoplasty for cervical spondylotic myelopathy. The Mantel-Haenszel method with the fixed-effects or random-effects model was used to calculate relative risks and 95% confidence intervals (CIs).

RESULTS

Seven studies with 224 patients met the eligibility criteria and were included. There was a significant difference in Japanese Orthopedic Association score (MD = 0.79, 95%CI [0.09, 1.49], P = .03; P for heterogeneity = .09, I = 45%), and adverse events (OR = 0.32, 95%CI [0.11, 0.95], P = .04; P for heterogeneity = 1.00, I = 0%) between the double door posterior cervical laminoplasty group and the single door posterior cervical laminoplasty group. There was no significance in operative time (MD = 0.56, 95%CI [-11.86, 12.98], P = .93; P for heterogeneity = 0.001, I = 73%) and length of hospital stay (OR = -0.75, 95%CI [-1.78, 0.27], P = .15; P for heterogeneity = 1.00, I = 0%) between the 2 groups.

CONCLUSION

Double door posterior cervical laminoplasty is more effective and safer than single door laminoplasty in the treatment of cervical spondylotic myelopathy.

Photogrammetric analysis: An objective measure to assess the craniocervical range of motion after cervical laminoplasty surgeries

Surgical decompression using laminoplasty is commonly performed for multilevel stenosis with cervical spondylotic myelopathy. However, the long-term effects on the craniocervical range of motion (ROM) after surgery are not well understood. This study represents the first entry into the literature of photogrammetric analysis for clinical measurement of craniocervical ROM. All patients underwent a French-door laminoplasty from 1995 to 2016 and were evaluated radiologically and with postoperative photographs (photogrammetric analysis) to measure craniocervical ROM and axial rotation. Radiographic parameters were occiput to C2 angle, C1-2 angle, C2-7 angle/cervical lordosis (CL), T1-slope (T1S), and TS-CL were measured. Chin-brow vertical angle (CBVA) was utilized for flexion and extension, while nose-turn angle (NTA) was used to assess axial rotation. Forty-four patients (mean age: 65.7 years, 50% female) had a mean follow-up of 37.9 months. Mean values in neutral, flexion, and extension were occiput to C2 = 30°, 15°, and 43°; C1-C2 = -32°, -25°, -32°; and C2-C7 = -4°, 11°, -20°, respectively. Mean CL was within 1 SD of the established -17° (±13.86°). Mean T1S and TS-CL were 33° and 30° in the neutral position, respectively. Mean radiographic full range of motion from flexion to extension was 53°. NTA towards patients' left was 48° and the right side was 45°. Mean CBVA, was -4°, mean flexion 37°, and extension -45°; full range was 81°. Global craniocervical ROM has proven to be well preserved for many years following cervical laminoplasty. Photogrammetric analysis is a cost-effective and radiation-free method, accurate for quantitative assessment of craniocervical and cervical ROM.

Plasma VDBP, 25(OH)D, and GSH levels predict surgical outcome in patients with cervical spondylotic myelopathy

This study intends to investigate the predictive values of plasma Vitamin D-binding protein (VDBP), 25-hydroxyvitamin D [25(OH)D], and glutathione (GSH) levels in the outcome of cervical spondylotic myelopathy (CSM) surgery. Surgery outcomes of 236 CSM patients were determined. Recovery rate was calculated according to Japanese Orthopaedic Association (JOA) scores during follow-up. CSM patients with a recovery rate >50% were assigned with good prognosis and the rest were with fair prognosis. Preoperative and postoperative neurologic function scores were compared among groups. Plasma VDBP and 25(OH)D levels, as well as GSH levels were measured by ELISA and glutathione reductase recycling assay, respectively. Pearson's correlation coefficient was performed to analyze the correlation among plasma VDBP, 25(OH)D, and GSH levels. Receiver operating characteristic (ROC) curve was applied to evaluate the predictive value of plasma VDBP, 25(OH)D, and GSH levels for surgical outcome. Logistic regression model was used to analyze risk factors for surgical outcome. Compared with those with fair prognosis, CSM patients with good prognosis group exhibited higher postoperative neurologic function scores, plasma VDBP, 25(OH)D, and GSH levels, and better improvements in spinal cord compression and motions of the cervical vertebra. Plasma VDBP, 25(OH)D, and GSH levels were favorable prognostic factors for CSM surgical outcome. The sensitivity and specificity of plasma VDBP, plasma 25(OH)D, and plasma GSH were 89.8% and 91.7%, 85.8% and 84.4%, and 79.5% and 91.7%, respectively. Our study provides evidence that higher plasma VDBP, 25(OH)D, and GSH levels may predict better surgical outcome in CSM patients.

Risk Factors for Significant Intraoperative Blood Loss During Unilateral Expansive Open-Door Cervical Laminoplasty for Cervical Compressive Myelopathy

OBJECTIVE

Unilateral expansive open-door cervical laminoplasty is an effective and safe procedure for cervical compressive myelopathy but occasionally is accompanied with significant intraoperative blood loss (SIBL). The aim of the present study was to elucidate the risk factors for SIBL in patients undergoing cervical laminoplasty for multilevel cervical compressive myelopathy and to identify the effect of SIBL on neurologic complications.

METHODS

A total of 215 patients who received cervical laminoplasty between January 2010 and August 2016 were enrolled in the study. SIBL was defined as 500 mL or more of blood volume during surgery. Patients were subdivided into 2 groups according to whether they suffered from SIBL (n = 26) or not (n = 189). Patient characteristics and clinical data were collected. Univariate and multivariable analysis were performed to identify independent risk factors for SIBL.

RESULTS

The incidence of SIBL during unilateral expansive open-door cervical laminoplasty was 12.1%. The multivariable logistic regression analysis showed Pavlov ratio (odds ratio [OR] 0.002, P = 0.009), ossification of the posterior longitudinal ligament (OR 2.677, P = 0.038), and number of complete hinge fractures (OR 1.842, P = 0.015) were independent risk factors for SIBL during cervical laminoplasty. Patients with SIBL during cervical laminoplasty had a greater rate of neurologic complications during hospitalization (P = 0.012), worse neurologic recovery rate at discharge (P = 0.01), and longer postoperative length of stay (P = 0.003).

CONCLUSIONS

This study suggested that Pavlov ratio, ossification of the posterior longitudinal ligament, and number of complete hinge fractures were independent risk factors for SBIL during cervical laminoplasty. SIBL in cervical laminoplasty was associated with greater neurologic complications and worse neurologic functional recovery.