Laminectomy and fusion better maintains horizontal gaze than laminoplasty in cervical spondylotic myelopathy

Q3 Medicine

North American Spine Society Journal Pub Date : 2024-11-24 DOI:10.1016/j.xnsj.2024.100575

Bradley T. Hammoor MD, MS , Lara L. Cohen MD, MPH , Grace X. Xiong MD , Harry M. Lightsey MD , Matthew Lindsey MD , Harold A. Fogel MD , Daniel G. Tobert MD , Stuart H. Hershman MD

{"title":"Laminectomy and fusion better maintains horizontal gaze than laminoplasty in cervical spondylotic myelopathy","authors":"Bradley T. Hammoor MD, MS , Lara L. Cohen MD, MPH , Grace X. Xiong MD , Harry M. Lightsey MD , Matthew Lindsey MD , Harold A. Fogel MD , Daniel G. Tobert MD , Stuart H. Hershman MD","doi":"10.1016/j.xnsj.2024.100575","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Laminectomy and fusion (LF) and laminoplasty (LP) are common treatments for cervical spondylotic myelopathy and myeloradiculopathy. While both procedures show similar clinical improvement, LF requires bony fusion while LP offers motion preservation. Cervical sagittal alignment and horizontal gaze maintenance are key outcome measures, but their comparative effects between LF and LP remain unclear. This study evaluated postoperative horizontal gaze and cervical sagittal alignment in patients undergoing either procedure.</div></div><div><h3>Methods</h3><div>In this retrospective cohort study at 2 academic centers, patients underwent either LF or LP. Pre/postoperative cervical sagittal alignment parameters were collected, including C2–7 lordosis, C2–7 SVA, Occiput-C2 angle, and T1-slope. The McGregor slope measured horizontal gaze, with 8° flexion to 13° extension as normal range. Primary outcome was horizontal gaze maintenance at minimum 1-year follow-up. Secondary outcomes included changes in cervical spine alignment parameters.</div></div><div><h3>Results</h3><div>Sixty-four patients (30 LF, 34 LP) completed minimum 1-year follow-up. Pre/postoperative sagittal alignment measures showed no significant differences between groups. Within cohorts, LP increased C2–7 sagittal vertical axis (29.1–37.6 mm, p=.04) while LF decreased C2–7 lordosis (11.5°–5.00°, p=.04). Postoperatively, LF showed significantly more optimally aligned patients (90.0%) versus LP (57.8%) (p<.01). Multivariate analysis indicated LP predicted postoperative horizontal gaze malalignment (OR 13.90 [2.10–286.62], p=.022).</div></div><div><h3>Conclusions</h3><div>While both procedures yielded comparable cervical sagittal alignment outcomes, LF demonstrated superior maintenance of horizontal gaze. These findings suggest that laminectomy and fusion may preserve horizontal gaze better than laminoplasty.</div><div><strong>Level of Evidence:</strong> III.</div></div>","PeriodicalId":34622,"journal":{"name":"North American Spine Society Journal","volume":"21 ","pages":"Article 100575"},"PeriodicalIF":0.0000,"publicationDate":"2024-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11731976/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"North American Spine Society Journal","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2666548424002683","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"Medicine","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Laminectomy and fusion (LF) and laminoplasty (LP) are common treatments for cervical spondylotic myelopathy and myeloradiculopathy. While both procedures show similar clinical improvement, LF requires bony fusion while LP offers motion preservation. Cervical sagittal alignment and horizontal gaze maintenance are key outcome measures, but their comparative effects between LF and LP remain unclear. This study evaluated postoperative horizontal gaze and cervical sagittal alignment in patients undergoing either procedure.

Methods

In this retrospective cohort study at 2 academic centers, patients underwent either LF or LP. Pre/postoperative cervical sagittal alignment parameters were collected, including C2–7 lordosis, C2–7 SVA, Occiput-C2 angle, and T1-slope. The McGregor slope measured horizontal gaze, with 8° flexion to 13° extension as normal range. Primary outcome was horizontal gaze maintenance at minimum 1-year follow-up. Secondary outcomes included changes in cervical spine alignment parameters.

Results

Sixty-four patients (30 LF, 34 LP) completed minimum 1-year follow-up. Pre/postoperative sagittal alignment measures showed no significant differences between groups. Within cohorts, LP increased C2–7 sagittal vertical axis (29.1–37.6 mm, p=.04) while LF decreased C2–7 lordosis (11.5°–5.00°, p=.04). Postoperatively, LF showed significantly more optimally aligned patients (90.0%) versus LP (57.8%) (p<.01). Multivariate analysis indicated LP predicted postoperative horizontal gaze malalignment (OR 13.90 [2.10–286.62], p=.022).

Conclusions

While both procedures yielded comparable cervical sagittal alignment outcomes, LF demonstrated superior maintenance of horizontal gaze. These findings suggest that laminectomy and fusion may preserve horizontal gaze better than laminoplasty.

Level of Evidence: III.

查看原文本刊更多论文

脊髓型颈椎病椎板切除术和融合术比椎板成形术更能维持水平凝视。

背景：椎板切除术和融合术（LF）和椎板成形术（LP）是治疗脊髓型颈椎病和脊髓根病的常用方法。虽然这两种手术的临床效果相似，但LF需要骨融合，而LP需要保持运动。颈椎矢状位对齐和水平凝视维持是关键的结局指标，但其在LF和LP之间的比较效果尚不清楚。本研究评估了接受这两种手术的患者术后水平凝视和颈椎矢状位对齐。方法：在2个学术中心的回顾性队列研究中，患者接受了LF或LP。收集术前/术后颈椎矢状面对准参数，包括C2-7前凸、C2-7 SVA、枕骨- c2角度和t1斜率。McGregor斜率测量水平凝视，正常范围为8°弯曲至13°延伸。在至少1年的随访中，主要终点为水平凝视维持。次要结局包括颈椎对准参数的改变。结果：64例患者（30例LF， 34例LP）完成了至少1年的随访。术前/术后矢状面对齐测量显示两组间无显著差异。在队列中，LP增加了C2-7矢状垂直轴（29.1-37.6 mm, p= 0.04），而LF减少了C2-7前凸（11.5°-5.00°，p= 0.04）。术后，LF患者（90.0%）比LP患者（57.8%）表现出更多的最佳对齐(结论：虽然两种手术都获得了相当的颈椎矢状位对齐结果，但LF表现出更好的水平凝视维持能力。这些发现表明椎板切除术和融合比椎板成形术更能保持水平凝视。证据水平：III。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊