Analysis of risk factors for axial symptoms after posterior cervical open-door laminoplasty

Abstract

Background: Laminoplasty (LP), a procedure commonly used to treat cervical spondylotic myelopathy (CSM), often results in the development of axial symptoms (AS) postoperatively. This study aims to analyze the risk factors associated with the occurrence of AS after LP.

Methods: We collected and evaluated clinical data from 264 patients with CSM who underwent LP treatment at our institution from January 2018 to January 2022 through a single-center retrospective study. Of the patients, 153 were male and 111 were female, with an average age of 58.1 ± 6.7 years. All patients underwent C3-7 posterior laminoplasty. Based on the occurrence of postoperative axial symptoms, the patients were divided into an AS group and a non-AS group. General information, including age, gender, disease duration, Japanese Orthopaedic Association (JOA) score, postoperation early function training, and collar-wearing time, was recorded and compared between the two groups. Surgical-related data, such as operative segments, surgical time, intraoperative blood loss, intraoperative facet joint destruction, and destruction of the C7 spinous process muscle insertion, were also compared. Imaging data, including preoperative cervical curvature, cervical range of motion, preoperative encroachment rate of the anterior spinal canal, and angle of laminar opening, were collected. Univariate and multivariate logistic regression analyses were used to identify risk factors for the development of AS after LP, and receiver operator characteristic (ROC) curves were utilized to explore the optimal preoperative parameters.

Results: All 264 patients successfully underwent surgery and were followed up for an average of 19.5 ± 6.8 months. At the 6-month follow-up, 117 patients were diagnosed with AS, resulting in an incidence rate of 40.2%. The multivariate logistic regression analysis identified that preoperative encroachment rate of anterior spinal canal (Pre-op ERASC), intraoperative facet joints destruction (Intra-op FJD), intraoperative open-door angle (Intra-op OA), destroy the C7 spinous process muscle insertion (Destroy C7 SPMI), postoperative loss of cervical curvature (Post-op LCC), and postoperative loss of cervical range of motion (Post-op LCROM) were independent risk factors for AS. Conversely, preoperative cervical curvature (Pre-op CC) and postoperation early function training (Post-op EFT) were protective factors against AS. According to the ROC curve, the cutoff values for preoperative anterior spinal canal occupation rate and preoperative cervical curvature were 28.5% and 16.5°, respectively. When the preoperative anterior spinal canal occupation rate was greater than 28.5% or the preoperative cervical curvature was less than 16.5°, AS was more likely to occur after surgery.

Conclusion: High preoperative anterior spinal canal occupation rate, facet joint damage during surgery, C7 spinous process muscle stop point damage, larger angle of laminar opening, and greater postoperative cervical curvature loss and cervical range of motion loss are associated with an increased risk of developing AS after cervical laminoplasty. Conversely, a larger preoperative cervical curvature and early postoperative functional exercises can help reduce the occurrence of AS.

Keywords: Axial symptoms; Cervical spondylotic myelopathy; Cutoff value; Laminoplasty; Risk factors.

Fig. 1

The cervical spine was taken in a neutral position, and the cervical curvature was represented by the angle between the tangent line of C2 and the lower edge of C7 vertebral body. The loss of cervical curvature = postoperative cervical curvature—preoperative cervical curvature

Fig. 2

The hyperextension and hyperflexion position of cervical spine was taken before and after operation. Cervical range of motion = extension Cobb angle + flexion Cobb angle, loss of cervical range of motion = postoperative range of motion-preoperative range of motion

Fig. 3

Preoperative encroachment rate of anterior spinal canal = AB / AC × 100%

Fig. 4

Opening angle = postoperative lamina angle (β)-preoperative lamina angle (α). The average value of the opening angle of each segment is the intraoperative opening angle

Fig. 5

Forest plot of risk factors for AS after posterior cervical open-door laminoplasty. The OR for OA, Pre-op ERASC, LCROM, LCC, destroy C7 SPMI, and intra-op FJD are all less than 1, indicating that they are risk factors for the occurrence of AS after LP. Conversely, the OR values for Pre-op CC and Post-op EFT are both greater than 1, suggesting that they serve as protective factors against the development of AS following LP

Fig. 6

ROC curve of Pre-op CC, Pre-op ERASC, and AS risk. a, b The ROC area of Pre-op CC and Pre-op ERASC was 0.626 (CI 0.558, 0.694) and 0.653 (CI 0.585, 0.722), respectively, both greater than 0.5, suggesting that the predictive accuracy of these two risk factors for the occurrence of AS is general, considering that the occurrence of AS may be the result of a combination of multiple risk factors

Fig. 7

A 61-year-old female patient underwent C3-7 single-door posterior laminoplasty in our hospital. At 6 months after operation, the patient still had axial symptoms such as neck and shoulder pain and numbness. a, d The preoperative cervical curvature and postoperative cervical curvature were 5.8°and 3.0°, respectively, and the loss of cervical range of motion was 2.8°. b, c, e, f The preoperative cervical range of motion and postoperative cervical range of motion were 28.2°and 19.6°, respectively, and the loss of cervical range of motion was 8.6°. g, h The preoperative and postoperative lamina angles were 36.0°and 51.2°, respectively, and the opening angle was≈15.2°(only one segment was listed here, and the final opening angle was the average opening angle of all surgical stages, so ≈ was used here). i preoperative encroachment rate of anterior spinal canal = 38.0%