Hsuan-Yu Chen1,2,3, Min-Hui Yang3, Yen-Po Lin3, Feng-Huei Lin2, Po-Quang Chen1, Ming-Hsiao Hu4, Shu-Hua Yang5. 1. Department of Orthopedics, National Taiwan University College of Medicine and National Taiwan University Hospital, No. 7, Chung-Shan South Road, Zhong-Zheng District, Taipei City, 100, Taiwan. 2. Institute of Biomedical Engineering, National Taiwan University, Taipei City, Taiwan. 3. Department of Orthopedic Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City, Taiwan. 4. Department of Orthopedics, National Taiwan University College of Medicine and National Taiwan University Hospital, No. 7, Chung-Shan South Road, Zhong-Zheng District, Taipei City, 100, Taiwan. gbhu0214@yahoo.com.tw. 5. Department of Orthopedics, National Taiwan University College of Medicine and National Taiwan University Hospital, No. 7, Chung-Shan South Road, Zhong-Zheng District, Taipei City, 100, Taiwan. shuhuayang@ntu.edu.tw.
Abstract
PURPOSE: No standard strategy exists for managing cervical spondylotic myelopathy (CSM). The efficacy of spinous process-splitting laminoplasty, its impact on cervical alignment change and the incidence of postoperative neck pain remain unclear. We analyzed the parameters of cervical alignment and cord morphology in CSM. METHODS: The radiographic parameters investigated were pre- and postoperative C2-C7 lordosis (CL), C2-C7 sagittal vertical axis (CSVA), T1 slope (TS), TS minus CL (TS - CL) and cervical spinal cord morphology. Myelopathy severity was measured using two different functional scores. Statistical analysis was performed to determine significant differences between preoperative and follow-up radiological findings and change in functional scores. RESULTS: This retrospective study comprised 85 CSM patients from a single institute, with a minimum follow-up of 24 months. Overall, 63.5% (n = 54) of patients had improvement in their postoperative cervical lordotic alignment; 36.5% (n = 31) developed progressive aggravation of the cervical kyphotic alignment. Pearson correlation analysis showed that CSVA, TS and T1-CL were independent predictors of CL curve change. Based on the receiver operating characteristic curve, the cutoff value for CSVA was 2.89 cm with a postoperative visual analog scale (VAS) > 4. The cutoff value of the TS - CL was 20 degrees with a postoperative VAS > 4. CSVA, TS and TS - CL had a significant association with variation in CL. CSVA and TS - CL had a significant association with postoperative neck pain. CONCLUSIONS: CSVA, T1 slope and T1-CL are good predictors of postoperative degenerative kyphotic change and neck pain. Careful consideration of their preoperative cutoff values can improve postoperative outcomes. LEVEL OF EVIDENCE: IV. These slides can be retrieved under Electronic Supplementary Material.
PURPOSE: No standard strategy exists for managing cervical spondylotic myelopathy (CSM). The efficacy of spinous process-splitting laminoplasty, its impact on cervical alignment change and the incidence of postoperative neck pain remain unclear. We analyzed the parameters of cervical alignment and cord morphology in CSM. METHODS: The radiographic parameters investigated were pre- and postoperative C2-C7 lordosis (CL), C2-C7 sagittal vertical axis (CSVA), T1 slope (TS), TS minus CL (TS - CL) and cervical spinal cord morphology. Myelopathy severity was measured using two different functional scores. Statistical analysis was performed to determine significant differences between preoperative and follow-up radiological findings and change in functional scores. RESULTS: This retrospective study comprised 85 CSMpatients from a single institute, with a minimum follow-up of 24 months. Overall, 63.5% (n = 54) of patients had improvement in their postoperative cervical lordotic alignment; 36.5% (n = 31) developed progressive aggravation of the cervical kyphotic alignment. Pearson correlation analysis showed that CSVA, TS and T1-CL were independent predictors of CL curve change. Based on the receiver operating characteristic curve, the cutoff value for CSVA was 2.89 cm with a postoperative visual analog scale (VAS) > 4. The cutoff value of the TS - CL was 20 degrees with a postoperative VAS > 4. CSVA, TS and TS - CL had a significant association with variation in CL. CSVA and TS - CL had a significant association with postoperative neck pain. CONCLUSIONS:CSVA, T1 slope and T1-CL are good predictors of postoperative degenerative kyphotic change and neck pain. Careful consideration of their preoperative cutoff values can improve postoperative outcomes. LEVEL OF EVIDENCE: IV. These slides can be retrieved under Electronic Supplementary Material.