PMID- 37473811 OWN - NLM STAT- Publisher LR - 20231022 IS - 1878-1632 (Electronic) IS - 1529-9430 (Linking) VI - 23 IP - 11 DP - 2023 Nov TI - Impact of C3 laminectomy on cervical sagittal alignment in cervical laminoplasty: a prospective, randomized controlled trial comparing clinical and radiological outcomes between C3 laminectomy with C4-C6 laminoplasty and C3-C6 laminoplasty. PG - 1674-1683 LID - S1529-9430(23)03258-8 [pii] LID - 10.1016/j.spinee.2023.07.001 [doi] AB - BACKGROUND CONTEXT: C3 laminectomy in cervical laminoplasty is a modified laminoplasty technique that can preserve the semispinalis cervicis muscle attached to the C2 spinous process. Several previous studies have shown that this technique can lead to better outcomes of postoperative axial neck pain and C2-C3 range of motion (ROM) than conventional cervical laminoplasty. However, there is still a lack of understanding of total and proportional postoperative cervical sagittal alignment outcomes. PURPOSE: To assess the effects of C3 laminectomy in cervical laminoplasty on postoperative cervical alignment and clinical outcomes. DESIGN: A single-center, patient-blinded, randomized controlled trial. PATIENT SAMPLE: We included consecutive 126 patients diagnosed with cervical spondylotic myelopathy (CSM) or ossification of posterior longitudinal ligament (OPLL) who were scheduled for cervical laminoplasty from March 2017 to January 2020. OUTCOME MEASURES: The primary outcome measures were C2-C7 Cobb angle (CA) and neck disability index (NDI). Secondary outcomes measures included other clinical outcomes and radiographic parameters including segmental Cobb angle and presence of C2-C3 interlaminar fusion. METHODS: Patients were randomly allocated to either the C3 laminectomy with C4-C6 laminoplasty group (LN group) or the C3-C6 laminoplasty group (LP group) at a 1:1 ratio. Laminoplasty was performed using a unilateral open-door technique and stabilized with titanium mini plates. A linear mixed model analysis was employed to examine the longitudinal data from postoperative 1-year through 3-year. Additional analysis between three types of cervical sagittal alignment morphology was done. RESULTS: Among 122 patients who were randomly allocated to one of two groups (LN group, n=61; LP group, n=61), modified intent-to-treat analysis was done for 109 patients (LN group, n=51, LP group, n=58) who had available at least a year of postoperative data. Postoperative C2-C7 CA was not significantly different between the two groups. However, NDI was significantly different between the two groups (12.8+/-1.0 in the LN group vs 8.6+/-1.0 in LP group, p=.005), which exceeded the minimum clinically important difference (MCID). The postoperative C2-C3 CA was significantly greater in the LN group (7.1+/-0.5 degrees in LN group vs 3.2+/-0.5 degrees in LP group, p<.001) while C4-C7 CA was significantly smaller in the LN group (3.9+/-0.8 degrees in LN group vs 7.7+/-0.7 degrees in LP group, p<.001) with greater cSVA in the LN group (31.6+/-1.4 mm in LN group vs 25.5+/-1.3 mm in LP group at postoperative 3-year, p=.002). Postoperative Euro-Quality of Life-5 Dimension (EQ-5D), numerical rating scores for neck pain (NRS-N) were significantly better in the LP group than in the LN group (all p<.05) and only EQ-5D surpassed the MCID. The C2-C3 fusion rate was significantly different between the LN group (9.8%) and the LP group (44.8%) (p<.001). The LN group showed a higher prevalence of a specific cervical alignment morphology characterized by a sigmoid shape with proximal lordosis and distal kyphosis (S curve). This S curve demonstrated significantly unfavorable outcomes across multiple outcome variables. CONCLUSION: The impact of C3 laminectomy in cervical laminoplasty on postoperative kyphosis among patients with CSM or OPLL did not significantly differ from that of C3-C6 laminoplasty. However, C3 laminectomy in cervical laminoplasty might result in an unfavorable clinical outcome with an unbalanced cervical sagittal alignment characterized by a sigmoid shape with proximal lordosis and distal kyphosis. CI - Copyright (c) 2023 Elsevier Inc. All rights reserved. FAU - Kim, Jun-Hoe AU - Kim JH AD - Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea. FAU - Yuh, Woon Tak AU - Yuh WT AD - Department of Neurosurgery, College of Medicine, Hallym University, 1, Hallymdaehak-gil, Chuncheon, 24252, South Korea; Department of Neurosurgery, Hallym University Dongtan Sacred Heart Hospital, 7, Keunjaebong-gil, Hwaseong, 18450, South Korea. FAU - Han, Junghoon AU - Han J AD - Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea. FAU - Kim, Taeshin AU - Kim T AD - Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea. FAU - Lee, Chang-Hyun AU - Lee CH AD - Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea; Department of Neurosurgery, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea. FAU - Kim, Chi Heon AU - Kim CH AD - Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea; Department of Neurosurgery, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea. FAU - Choi, Yunhee AU - Choi Y AD - Division of Medical Statistics, Medical Research Collaborating Center, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea. FAU - Chung, Chun Kee AU - Chung CK AD - Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea; Department of Neurosurgery, Seoul National University College of Medicine, 103, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea; Department of Brain and Cognitive Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, South Korea. Electronic address: chungc@snu.ac.kr. LA - eng PT - Journal Article DEP - 20230719 PL - United States TA - Spine J JT - The spine journal : official journal of the North American Spine Society JID - 101130732 SB - IM OTO - NOTNLM OT - C3 laminectomy OT - CSM OT - Cervical lordosis OT - Laminoplasty OT - OPLL OT - Sagittal vertical axis COIS- Declaration of Competing Interest None declared. EDAT- 2023/07/21 01:12 MHDA- 2023/07/21 01:12 CRDT- 2023/07/20 19:23 PHST- 2023/03/29 00:00 [received] PHST- 2023/06/12 00:00 [revised] PHST- 2023/07/01 00:00 [accepted] PHST- 2023/07/21 01:12 [pubmed] PHST- 2023/07/21 01:12 [medline] PHST- 2023/07/20 19:23 [entrez] AID - S1529-9430(23)03258-8 [pii] AID - 10.1016/j.spinee.2023.07.001 [doi] PST - ppublish SO - Spine J. 2023 Nov;23(11):1674-1683. doi: 10.1016/j.spinee.2023.07.001. Epub 2023 Jul 19.