Professor of Neurosurgery University of Arizona Tucson, Arizona, United States
Introduction: The potential impact of sagittal alignment on postoperative neurologic function and patient-reported outcomes is increasingly being studied in the context of cervical laminoplasty. Laminoplasty techniques vary and particular variability exists amongst reported measures associated with postoperative pain. Herein we describe recent experience with patients undergoing floating cervical laminoplasty with particular attention to sagittal alignment and postoperative pain.
Methods: Consecutive patients who underwent floating cervical laminoplasty between 2021 – 2023 were retrospectively reviewed. Patient demographics and radiographic measures were collected, including C2-C7 sagittal vertical axis (cSVA), C2-C7 cervical lordosis (CL), T1 slope (TS), and TS minus CL (TS-CL). TS-CL mismatch was defined as TS-CL > 20 degrees. Pain was assessed using the visual analog scale (VAS). Myelopathy was graded using the modified Japanese Orthopedic Association score and Nurick scale. Patients with clinically significant postoperative pain (VAS > 3) were compared to those without pain (VAS ≤ 3), assessing group differences and relationships between individual measures.
Results: Single institution data from 11 patients with greater than 6 months of follow-up was included for analysis. Mean mJOA scores improved from 13.9 to 16.1, attributed largely to improvement in upper extremity function. Average Nurick scores improved from 2 to 1, reflecting improved ambulation. Pre- and postoperative sagittal measures (cSVA, CL, TS, and TS-CL) were similar between patients with postoperative pain and those without pain. Most notably, mean postoperative TS-CL exceeded 20 degrees for patients with clinically significant pain (23.8 ± 5) and those without pain (24.8 ± 8). Similarly, no reliable correlation was observed between individual sagittal measures and pain.
Conclusion : In the absence of marked cervical deformity, cervical sagittal plane abnormalities may not reliably predict postoperative pain following cervical laminoplasty, especially when considered independently from global spinal alignment.
