Does Segmental Kyphosis Affect Surgical Outcome after a Posterior Decompressive Laminectomy in Multisegmental Cervical Spondylotic Myelopathy?
Study DesignRetrospective analysis.PurposeTo compare results of laminectomy in multisegmental compressive cervical myelopathy (CSM) with lordosis versus segmental kyphosis.Overview of LiteratureLaminectomy is an established procedure for decompression in CSM with cervical lordosis. However in patien...
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doaj-4544c596e1764a0fb84e19a3a824091f2020-11-24T22:06:38ZengKorean Spine SocietyAsian Spine Journal1976-19021976-78462017-02-01111243010.4184/asj.2017.11.1.24209Does Segmental Kyphosis Affect Surgical Outcome after a Posterior Decompressive Laminectomy in Multisegmental Cervical Spondylotic Myelopathy?Akshay Jain0Tarush Rustagi1Gautam Prasad2Tushar Deore3Shekhar Y. Bhojraj4Spine Unit, Lilavati Hospital and Breach Candy Hospital, Mumbai, India.Spine Unit, Lilavati Hospital and Breach Candy Hospital, Mumbai, India.Spine Unit, Lilavati Hospital and Breach Candy Hospital, Mumbai, India.Spine Unit, Lilavati Hospital and Breach Candy Hospital, Mumbai, India.Spine Unit, Lilavati Hospital and Breach Candy Hospital, Mumbai, India.Study DesignRetrospective analysis.PurposeTo compare results of laminectomy in multisegmental compressive cervical myelopathy (CSM) with lordosis versus segmental kyphosis.Overview of LiteratureLaminectomy is an established procedure for decompression in CSM with cervical lordosis. However in patients with segmental kyphosis, it is associated with risk of progression of kyphosis and poor outcome. Whether this loss of sagittal alignment affects functional outcome is not clear.MethodsWe retrospectively reviewed 68 patients who underwent laminectomy for CSM from 1998 to 2009. As per preoperative magnetic resonance images, 36 patients had preoperative lordosis (Group 1) and 32 had segmental kyphosis (Group 2). We studied age at the time of surgery, duration of preoperative symptoms, recovery rate, magnitude of postoperative backward shifting of spinal cord and loss of sagittal alignment.ResultsMean follow up was 5.05 years (range, 2–13 years) and mean age at the time of surgery 61.88 years. Group 1 had 20 men and 16 women and Group 2 had 19 men and 13 women. Mean recovery rate in Group 1 was 60.32%, in Group 2 was 63.7% without any statistical difference (p-value 0.21, one tailed analysis of variance). Two patients of Group 1 had loss of cervical lordosis by five degrees. In Group 2 seven patients had progression of segmental kyphosis by 5–10 degrees and two patients by more than 10 degrees. Mean cord shift was more in Group 1 (mean, 2.41 mm) as compared to Group 2 (mean, –1.97 mm) but it had no correlation to recovery rate. Patients with younger age (mean, 57 years) and less duration of preoperative symptoms (mean, 4.86 years) had better recovery rate (75%).ConclusionsClinical outcome in CSM is not related to preoperative cervical spine alignment. Thus, lordosis is not mandatory for planning laminectomy in CSM. Good outcome is expected in younger patients operated earliest after onset of symptoms.http://www.asianspinejournal.org/upload/pdf/asj-11-24.pdfCervical myelopathyLaminectomyLordosis |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Akshay Jain Tarush Rustagi Gautam Prasad Tushar Deore Shekhar Y. Bhojraj |
spellingShingle |
Akshay Jain Tarush Rustagi Gautam Prasad Tushar Deore Shekhar Y. Bhojraj Does Segmental Kyphosis Affect Surgical Outcome after a Posterior Decompressive Laminectomy in Multisegmental Cervical Spondylotic Myelopathy? Asian Spine Journal Cervical myelopathy Laminectomy Lordosis |
author_facet |
Akshay Jain Tarush Rustagi Gautam Prasad Tushar Deore Shekhar Y. Bhojraj |
author_sort |
Akshay Jain |
title |
Does Segmental Kyphosis Affect Surgical Outcome after a Posterior Decompressive Laminectomy in Multisegmental Cervical Spondylotic Myelopathy? |
title_short |
Does Segmental Kyphosis Affect Surgical Outcome after a Posterior Decompressive Laminectomy in Multisegmental Cervical Spondylotic Myelopathy? |
title_full |
Does Segmental Kyphosis Affect Surgical Outcome after a Posterior Decompressive Laminectomy in Multisegmental Cervical Spondylotic Myelopathy? |
title_fullStr |
Does Segmental Kyphosis Affect Surgical Outcome after a Posterior Decompressive Laminectomy in Multisegmental Cervical Spondylotic Myelopathy? |
title_full_unstemmed |
Does Segmental Kyphosis Affect Surgical Outcome after a Posterior Decompressive Laminectomy in Multisegmental Cervical Spondylotic Myelopathy? |
title_sort |
does segmental kyphosis affect surgical outcome after a posterior decompressive laminectomy in multisegmental cervical spondylotic myelopathy? |
publisher |
Korean Spine Society |
series |
Asian Spine Journal |
issn |
1976-1902 1976-7846 |
publishDate |
2017-02-01 |
description |
Study DesignRetrospective analysis.PurposeTo compare results of laminectomy in multisegmental compressive cervical myelopathy (CSM) with lordosis versus segmental kyphosis.Overview of LiteratureLaminectomy is an established procedure for decompression in CSM with cervical lordosis. However in patients with segmental kyphosis, it is associated with risk of progression of kyphosis and poor outcome. Whether this loss of sagittal alignment affects functional outcome is not clear.MethodsWe retrospectively reviewed 68 patients who underwent laminectomy for CSM from 1998 to 2009. As per preoperative magnetic resonance images, 36 patients had preoperative lordosis (Group 1) and 32 had segmental kyphosis (Group 2). We studied age at the time of surgery, duration of preoperative symptoms, recovery rate, magnitude of postoperative backward shifting of spinal cord and loss of sagittal alignment.ResultsMean follow up was 5.05 years (range, 2–13 years) and mean age at the time of surgery 61.88 years. Group 1 had 20 men and 16 women and Group 2 had 19 men and 13 women. Mean recovery rate in Group 1 was 60.32%, in Group 2 was 63.7% without any statistical difference (p-value 0.21, one tailed analysis of variance). Two patients of Group 1 had loss of cervical lordosis by five degrees. In Group 2 seven patients had progression of segmental kyphosis by 5–10 degrees and two patients by more than 10 degrees. Mean cord shift was more in Group 1 (mean, 2.41 mm) as compared to Group 2 (mean, –1.97 mm) but it had no correlation to recovery rate. Patients with younger age (mean, 57 years) and less duration of preoperative symptoms (mean, 4.86 years) had better recovery rate (75%).ConclusionsClinical outcome in CSM is not related to preoperative cervical spine alignment. Thus, lordosis is not mandatory for planning laminectomy in CSM. Good outcome is expected in younger patients operated earliest after onset of symptoms. |
topic |
Cervical myelopathy Laminectomy Lordosis |
url |
http://www.asianspinejournal.org/upload/pdf/asj-11-24.pdf |
work_keys_str_mv |
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