Predictors for cervical kyphotic deformity following laminoplasty: a systematic review and meta-analysis

Samuel D. PetterssonNeurosurgery Department, Medical University of Gdansk, Poland;

Search for other papers by Samuel D. Pettersson in
jns
Google Scholar
PubMed
Close
,
Paulina SkrzypkowskaNeurosurgery Department, Medical University of Gdansk, Poland;

Search for other papers by Paulina Skrzypkowska in
jns
Google Scholar
PubMed
Close
,
Shan AliNeurology Department, Mayo Clinic, Jacksonville, Florida; and

Search for other papers by Shan Ali in
jns
Google Scholar
PubMed
Close
 MD
,
Tomasz SzmudaNeurosurgery Department, Medical University of Gdansk, Poland;

Search for other papers by Tomasz Szmuda in
jns
Google Scholar
PubMed
Close
 MD, PhD
,
Michał KrakowiakNeurosurgery Department, Medical University of Gdansk, Poland;

Search for other papers by Michał Krakowiak in
jns
Google Scholar
PubMed
Close
 MD
,
Tadej PočivavšekNeurosurgery Department, Medical University of Gdansk, Poland;

Search for other papers by Tadej Počivavšek in
jns
Google Scholar
PubMed
Close
,
Fanny SunessonNeurosurgery Department, Medical University of Gdansk, Poland;

Search for other papers by Fanny Sunesson in
jns
Google Scholar
PubMed
Close
,
Justyna FerchoNeurosurgery Department, Medical University of Gdansk, Poland;

Search for other papers by Justyna Fercho in
jns
Google Scholar
PubMed
Close
 MD
, and
Grzegorz MiękisiakInstitute of Medicine, Opole University, Opole, Poland

Search for other papers by Grzegorz Miękisiak in
jns
Google Scholar
PubMed
Close
 MD, PhD
Restricted access

Purchase Now

USD  $45.00

Spine - 1 year subscription bundle (Individuals Only)

USD  $384.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $624.00
USD  $45.00
USD  $384.00
USD  $624.00
Print or Print + Online Sign in

OBJECTIVE

Laminoplasty is a common treatment for cervical spondylotic myelopathy (CSM) and for ossification of the posterior longitudinal ligament (OPLL). However, approximately 21% of patients undergoing laminoplasty develop cervical kyphotic deformity (KD). Because of the high prevalence rate of KD, several studies have sought to identify predictors for this complication, but the findings remain highly inconsistent. Therefore, the authors performed a systematic review and meta-analysis to establish reliable preoperative predictors of KD.

METHODS

PubMed, Scopus, and Web of Science databases were used to systematically extract potential references. The first phase of screening required the studies to be written in the English language, involve patients treated for CSM and/or OPLL via laminoplasty, and report postoperative cervical KD. The second phase required the studies to provide more than 10 patients and include a control group. The mean difference (MD) and odds ratio (OR) were calculated for continuous and dichotomous parameters. Study quality was evaluated using the Newcastle-Ottawa Scale. CSM and OPLL patients were further assessed by performing subgroup analyses.

RESULTS

Thirteen studies comprising patients who developed cervical KD (n = 296) and no KD (n = 1254) after receiving cervical laminoplasty for CSM or OPLL were included in the meta-analysis. All studies were retrospective cohorts and were rated as high quality. In the combined univariate analysis of CSM and OPLL patients undergoing laminoplasty, statistically significant predictors for postoperative KD included age (MD 2.22, 95% CI 0.16–4.27, p = 0.03), preoperative BMI (MD 0.85, 95% CI 0.06–1.63, p = 0.04), preoperative C2–7 range of flexion (MD 10.42, 95% Cl 4.24–16.59, p = 0.0009), preoperative C2–7 range of extension (MD −4.59, 95% CI −6.34 to −2.83, p < 0.00001), and preoperative center of gravity of the head to the C7 sagittal vertical axis (MD 26.83, 95% CI 9.13–44.52, p = 0.003). Additionally, among CSM patients, males were identified as having a greater risk for postoperative KD (OR 1.73, 95% CI 1.02–2.93, p = 0.04).

CONCLUSIONS

The findings from this study currently provide the largest and most reliable review on preoperative predictors for cervical KD after laminoplasty. Given that several of the included studies identified optimal cutoff points for the variables that are significantly associated with KD, further investigation into the development of a preoperative risk scoring system that can accurately predict KD in the clinical setting is encouraged.

PROSPERO registration no.: CRD42022299795 (https://www.crd.york.ac.uk/PROSPERO/).

ABBREVIATIONS

CGH–C7 SVA = center of gravity of the head to the C7 SVA; CI = confidence interval; CL = cervical lordosis; CSM = cervical spondylotic myelopathy; eROM = extension ROM; fROM = flexion ROM; KD = kyphotic deformity; MD = mean difference; OPLL = ossification of the posterior longitudinal ligament; OR = odds ratio; PMLC = posterior muscular-ligament complex; PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses; ROM = range of motion; SVA = sagittal vertical axis.

Supplementary Materials

    • Supplementary Table and Figures (PDF 2,859 KB)
  • Collapse
  • Expand

Illustration from Beck et al. (pp 147–152). © Department of Neurosurgery, Freiburg Medical Center; published with permission.

  • 1

    Abe T, Miyazaki M, Ishihara T, et al. Analysis of the risk factors for increasing cervical sagittal vertical axis after cervical laminoplasty for cervical spondylotic myelopathy. Arch Orthop Trauma Surg. 2022;142(4):553560.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Cao JM, Zhang JT, Yang DL, Yang L, Shen Y. Multivariate analysis of factors associated with kyphotic deformity after laminoplasty in cervical spondylotic myelopathy patients without preoperative kyphotic alignment. Sci Rep. 2017;7:

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Choi I, Roh SW, Rhim SC, Jeon SR. The time course of cervical alignment after cervical expansive laminoplasty: determining optimal cut-off preoperative angle for predicting postoperative kyphosis. Medicine (Baltimore). 2018;97(47):e13335.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Fujishiro T, Hayama S, Obo T, et al. Gap between flexion and extension ranges of motion: a novel indicator to predict the loss of cervical lordosis after laminoplasty in patients with cervical spondylotic myelopathy. J Neurosurg Spine. 2021;35(1):817.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5

    Jeon H, Kim HC, Kim TW, et al. Prediction of angular kyphosis after cervical laminoplasty using radiologic measurements. J Clin Neurosci. 2021;85:1319.

  • 6

    Lee JS, Son DW, Lee SH, Kim DH, Lee SW, Song GS. The predictable factors of the postoperative kyphotic change of sagittal alignment of the cervical spine after the laminoplasty. J Korean Neurosurg Soc. 2017;60(5):577583.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Lee SH, Son DW, Lee JS, Sung SK, Lee SW, Song GS. Does extension dysfunction affect postoperative loss of cervical lordosis in patients who undergo laminoplasty? Spine (Phila Pa 1976). 2019;44(8):E456E464.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Matsuoka Y, Endo K, Nishimura H, et al. Cervical kyphotic deformity after laminoplasty in patients with cervical ossification of posterior longitudinal ligament with normal sagittal spinal alignment. Spine Surg Relat Res. 2018;2(3):210214.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Oe S, Kurosu K, Hasegawa T, et al. Risk factors for cervical deformity after posterior cervical decompression surgery: a multicenter study. Global Spine J. Published online August 4, 2021. doi:

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Ono K, Murata S, Matsushita M, Murakami H. Cervical lordosis ratio as a novel predictor for the loss of cervical lordosis after laminoplasty. Neurospine. 2021;18(2):311318.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Sakai K, Yoshii T, Hirai T, et al. Cervical sagittal imbalance is a predictor of kyphotic deformity after laminoplasty in cervical spondylotic myelopathy patients without preoperative kyphotic alignment. Spine (Phila Pa 1976). 2016;41(4):299305.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Sakai K, Yoshii T, Arai Y, et al. K-line tilt is a predictor of postoperative kyphotic deformity after laminoplasty for cervical myelopathy caused by ossification of the posterior longitudinal ligament. Global Spine J. Published online May 5, 2021. doi: 10.1177/21925682211012687

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Xu C, Zhang Y, Dong M, et al. The relationship between preoperative cervical sagittal balance and clinical outcome of laminoplasty treated cervical ossification of the posterior longitudinal ligament patients. Spine J. 2020;20(9):14221429.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Hirai T, Kawabata S, Enomoto M, et al. Presence of anterior compression of the spinal cord after laminoplasty inhibits upper extremity motor recovery in patients with cervical spondylotic myelopathy. Spine (Phila Pa 1976). 2012;37(5):377384.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Sodeyama T, Goto S, Mochizuki M, Takahaski J, Moriya H. Effect of decompression enlargement laminoplasty for posterior shifting of the spinal cord. Spine (Phila Pa 1976). 1999;24(15):15271532.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Albert TJ, Vacarro A. Postlaminectomy kyphosis. Spine (Phila Pa 1976). 1998;23(24):27382745.

  • 17

    Tsuji H. Laminoplasty for patients with compressive myelopathy due to so-called spinal canal stenosis in cervical and thoracic regions. Spine (Phila Pa 1976). 1982;7(1):2834.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Zhang J, Liang Q, Qin D, et al. The anterior versus posterior approach for the treatment of ossification of the posterior longitudinal ligament in the cervical spine: a systematic review and meta-analysis. J Spinal Cord Med. 2021;44(3):340349.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Fujishiro T, Nakano A, Yano T, et al. Significance of flexion range of motion as a risk factor for kyphotic change after cervical laminoplasty. J Clin Neurosci. 2020;76:100106.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Kim BJ, Cho SM, Hur JW, Cha J, Kim SH. Kinematics after cervical laminoplasty: risk factors for cervical kyphotic deformity after laminoplasty. Spine J. 2021;21(11):18221829.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Mattei TA, Goulart CR, Milano JB, Dutra LPF, Fasset DR. Cervical spondylotic myelopathy: pathophysiology, diagnosis, and surgical techniques. ISRN Neurol. 2011;2011:463729.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Choi BW, Song KJ, Chang H. Ossification of the posterior longitudinal ligament: a review of literature. Asian Spine J. 2011;5(4):267276.

  • 23

    Matsunaga S, Sakou T, Taketomi E, Komiya S. Clinical course of patients with ossification of the posterior longitudinal ligament: a minimum 10-year cohort study. J Neurosurg. 2004;100(3)(Suppl Spine):245248.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    The Cochrane Collaboration. 7.7.3.3 Obtaining standard deviations from standard errors. In: Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions. Accessed July 14, 2022. https://handbook-5-1.cochrane.org/chapter_7/7_7_3_3_obtaining_standard_deviations_from_standard_errors.htm

    • Search Google Scholar
    • Export Citation
  • 25

    Chen X, Hao J, Fu T, Qin R, Zhang F. Surgery for cervical ossification of posterior longitudinal ligament (OPLL) via posterior laminoplasty. Interdiscip Neurosurg. 2020;19:100562.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 26

    Kato S, Nouri A, Wu D, Nori S, Tetreault L, Fehlings MG. Comparison of anterior and posterior surgery for degenerative cervical myelopathy: an MRI-based propensity-score-matched analysis using data from the prospective multicenter AOSpine CSM North America and international studies. J Bone Joint Surg Am. 2017;99(12):10131021.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27

    Fehlings MG, Barry S, Kopjar B, et al. Anterior versus posterior surgical approaches to treat cervical spondylotic myelopathy: outcomes of the prospective multicenter AOSpine North America CSM study in 264 patients. Spine (Phila Pa 1976). 2013;38(26):22472252.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28

    Badhiwala JH, Witiw CD, Nassiri F, et al. Efficacy and safety of surgery for mild degenerative cervical myelopathy: results of the aospine North America and international prospective multicenter studies. Neurosurgery. 2019;84(4):890897.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29

    El-Ghandour NMF, Soliman MAR, Ezzat AAM, Mohsen A, Zein-Elabedin M. The safety and efficacy of anterior versus posterior decompression surgery in degenerative cervical myelopathy: a prospective randomized trial. J Neurosurg Spine. 2020;33(3):288296.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 30

    Silver JR. History of the treatment of spinal injuries. Postgrad Med J. 2005;81(952):108114.

  • 31

    Zhao H, Ren R, Ma W, et al. Comparison of laminoplasty vs. laminectomy for cervical spondylotic myelopathy: a systematic review and meta-analysis. Front Surg. 2022;8:790593.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32

    Yoo S, Ryu D, Choi HJ, et al. Ossification foci act as stabilizers in continuous-type ossification of the posterior longitudinal ligament: a comparative study between laminectomy and laminoplasty. Acta Neurochir (Wien). 2017;159(9):17831790.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33

    Nishida N, Kanchiku T, Kato Y, et al. Biomechanical analysis of cervical myelopathy due to ossification of the posterior longitudinal ligament: effects of posterior decompression and kyphosis following decompression. Exp Ther Med. 2014;7(5):10951099.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34

    Hirabayashi K, Watanabe K, Wakano K, Suzuki N, Satomi K, Ishii Y. Expansive open-door laminoplasty for cervical spinal stenotic myelopathy. Spine (Phila Pa 1976). 1983;8(7):693699.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35

    Kurokawa T, Tsuyama N, Tanaka H, Kobayashi M, Machida H, Nakamura K. Double-door laminoplasty. Bessatsu Seikeigeka. 1982;2:234240.

  • 36

    Wiguna IGLNAA, Magetsari R, Noor Z, Suyitno S, Nindrea RD. Comparative effectiveness and functional outcome of open-door versus French-door laminoplasty for multilevel cervical myelopathy: a meta-analysis. Open Access Maced J Med Sci. 2019;7(19):33483352.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 2620 2620 290
Full Text Views 651 651 201
PDF Downloads 601 601 213
EPUB Downloads 0 0 0