Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2024 Aug;16(8):1893-1902.
doi: 10.1111/os.14120. Epub 2024 Jun 11.

Cervical Alignment and Range of Motion Change after Anterior 3-Level Hybrid Surgery Compared with Cervical Laminoplasty: A Matched Cohort Study

Yuxiao Deng  1 , Junbo He  1 , Hua Chen  1 , Beiyu Wang  1 , Quan Gong  1 , Tao Li  1 , Hao Liu  1
Affiliations
Comparative Study

Cervical Alignment and Range of Motion Change after Anterior 3-Level Hybrid Surgery Compared with Cervical Laminoplasty: A Matched Cohort Study

Yuxiao Deng et al. Orthop Surg. 2024 Aug.

Abstract

Objectives: Cervical alignment and range of motion (ROM) changes after cervical spine surgery are related to cervical biomechanical and functions. Few studies compared these parameters between posterior laminoplasty and anterior 3-level hybrid surgery incorporating anterior cervical discectomy and fusion (ACDF) with cervical disc replacement (CDR). This study is aimed to detect the differences of cervical alignment and ROM changes of the two surgeries in a matched-cohort study.

Methods: From January 2018 and May 2020, 51 patients who underwent 3-level hybrid surgery incorporating ACDF with ACDR were included. A 1:1 match of the patients who underwent cervical laminoplasty based on age, gender, duration of symptoms, body mass index, and cervical alignment type was utilized as control group. General data (operative time, blood loss, etc.), Japanese Orthopaedic Association (JOA) score, VAS (Visual Analog Score), NDI (The Neck Disability Index), cervical sagittal alignment, and cervical range of motion (ROM) were recorded and compared.

Results: Both groups gained significant improvement in JOA, VAS, NDI scores postoperatively (p < 0.05). Cervical alignment significantly increased in hybrid group and decreased in control group after surgeries (p < 0.001). ROM decrease was similar in two groups. For cervical lordosis, though cervical alignment angle in control group decreased, the final follow-up cervical alignment and cervical alignment changes were not significantly different between hybrid and control groups. For cervical non-lordosis, cervical alignment decreased in control group while increased in hybrid group. At final follow-up, cervical alignment and the changes between the two groups were significantly different. Both control group and hybrid group had similar ROM decrease after the surgery no matter whether there was cervical lordosis or non-lordosis. Hybrid surgery showed cervical alignments significantly improved and similar ROM preservation compared with control group at final follow-up both for 1-level and 2-level disc replacement subgroups.

Conclusions: The hybrid surgery demonstrated advantages of preserving cervical alignment and gaining similar cervical ROM preservation compared with cervical laminoplasty, especially for cervical non-lordosis. Given the importance of restoring lordotic cervical alignment, hybrid surgery may be preferred over laminoplasty to treat multilevel cervical disc herniation.

Keywords: Anterior Hybrid Surgery; Cervical Spine Alignment; Laminoplasty; Non‐Lordosis; ROM.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no conflict of interest concerning the materials or methods used in this study or the findings specified in this study. No relevant financial activities outside the submitted work need to be declared.

Figures

FIGURE 1
FIGURE 1
Measurement of cervical sagittal alignment (A), and cervical range of motion (B, C). α, the C2‐7 sagittal angle. Cervical range of motion = α1 + α2.
FIGURE 2
FIGURE 2
Toyama classification of cervical sagittal alignment: lordosis, straight, sigmoid, and kyphosis.
FIGURE 3
FIGURE 3
The change of cervical alignment and cervical range of motion (ROM) for different time points.
FIGURE 4
FIGURE 4
The subgroup comparison of cervical alignment and cervical range of motion (ROM) for different hybridized combination. * p < 0.05.
FIGURE 5
FIGURE 5
The subgroup comparison of cervical alignment and cervical range of motion (ROM) for different preoperative cervical alignment type. *p < 0.05.
See this image and copyright information in PMC

References

    1. Scheer JK, Tang JA, Smith JS, Protopsaltis TS, Blondel B, Bess S, et al. Cervical spine alignment, sagittal deformity, and clinical implications: a review. J Neurosurg Spine. 2013;19(2):141–159. - PubMed
    1. Ames CP, Blondel B, Scheer JK, Schwab FJ, le Huec JC, Massicotte EM, et al. Cervical radiographical alignment: comprehensive assessment techniques and potential importance in cervical myelopathy. Spine (Phila Pa 1976). 2013;38(22 Suppl 1):S149–S160. - PubMed
    1. Tundo F, Avila MJ, Willard L, Fanous S, Curri C, Hussain I, et al. Spinal alignment, surgery, and outcomes in cervical deformity: a practical guide to aid the spine surgeon. Clin Neurol Neurosurg. 2019;185:105496. - PubMed
    1. Shin JJ. Comparison of adjacent segment degeneration, cervical alignment, and clinical outcomes after one‐ and multilevel anterior cervical discectomy and fusion. Neurospine. 2019;16(3):589–600. - PMC - PubMed
    1. Qi C, Cao J, Xia H, Miao D, Liu Y, Guo J, et al. Does cervical curvature affect neurological outcome after incomplete spinal cord injury without radiographic abnormality (SCIWORA): 1‐year follow‐up. J Orthop Surg Res. 2022;17(1):361. - PMC - PubMed

Publication types