A retrospective single-center study.
The aim of this study was to evaluate the compensatory mechanism
of cervical lordosis
(CL), the changes in cervical sagittal alignment, and range of motion (ROM) after muscle-preserving selective laminectomy
Summary of Background Data.
CL increases as a compensatory mechanism
for the adjustment of cervical sagittal balance
or horizontal gaze. However, laminoplasty
invades this mechanism and causes kyphosis in higher T1 (C7) slope patients.
SL is a posterior surgery selecting the decompression laminae without disturbing the extensor musculature and facet joints. The clinical features and radiological findings of 125 cervical compressive myelopathy
patients who underwent C6 single-level SL, C5-C6 two consecutive levels SL, C4-C6 three consecutive levels SL, and C3-C6 four consecutive levels SL were enrolled. Cervical spine lateral radiography was performed before surgery and at the final follow-up. The patients were divided into two groups according to the preoperative C7 slope
. Postoperative cervical alignment
change was compared between the higher and lower C7 slope
groups. Subsequently, pre- and postoperative cervical alignment
and cervical ROM were analyzed according to the number of consecutive laminae surgically treated.
Patients with higher C7 slope
had greater lordotic cervical alignment
and larger C2-C7 sagittal vertical axis
(SVA) pre- and postoperatively. No kyphotic alignment change was observed, even in the higher C7 slope
group. C6 SL and C5-C6 SL did not affect C2-C7 angle, and did not increase C2-C7 SVA after surgery. Although C4-C6 SL and C3-C6 SL demonstrated postoperative slight increase in C2-C7 SVA, C2-C7 angle never decreased after surgery. Cervical ROM slightly reduced in the C4-C6 SL and C3-C6 SL groups; however, no reduction of ROM was observed in the C6 SL and C5-C6 SL groups.
SL preserved the inherent compensatory CL that had been observed preoperatively and maintained cervical sagittal balance
Level of Evidence: 4