Muscle-Preserving Selective Laminectomy Maintained the Compensatory Mechanism of Cervical Lordosis After Surgery

STUDY DESIGN.A retrospective single-center study. OBJECTIVE.To evaluate the compensatory mechanism of cervical lordosis (CL), the changes in cervical sagittal alignment and range of motion (ROM) after muscle-preserving selective laminectomy (SL). SUMMARY OF BACKGROUND DATA.CL increases as a compensatory mechanism for the adjustment of cervical sagittal balance or horizontal gaze. However, laminoplasty invades this mechanism and causes kyphosis in higher T1 (C7) slope patients. METHODS.SL is a posterior surgery selecting the decompression laminae without disturbing the extensor musculature and facet joints. The clinical features and radiological findings of 125 cervical compressive myelopathy patients who underwent C6 single-level SL, C5-C6 two consecutive levels SL, C4-C6 three consecutive levels SL and C3-C6 four consecutive levels SL were enrolled. Cervical spine lateral radiography was performed before surgery and at the final follow-up. The patients were divided into 2 groups according to the preoperative C7 slope. Postoperative cervical alignment change was compared between the higher and lower C7 slope groups. Subsequently, pre- and postoperative cervical alignment and cervical ROM were analyzed according to the number of consecutive laminae surgically treated. RESULTS.Patients with higher C7 slope had greater lordotic cervical alignment and larger C2-C7 sagittal vertical axis (SVA) pre- and postoperatively. No kyphotic alignment change was observed, even in the higher C7 slope group. C6 SL and C5-C6 SL did not affect C2-C7 angle, and did not increase C2-C7 SVA after surgery. Although C4-C6 SL and C3-C6 SL demonstrated postoperative slight increase in C2-C7 SVA, C2-C7 angle never decreased after surgery. Cervical ROM slightly reduced in the C4-C6 SL and C3-C6 SL groups; however, no reduction of ROM was observed in the C6 SL and C5-C6 SL groups. CONCLUSIONS.SL preserved the inherent compensatory CL that had been observed preoperatively and maintained cervical sagittal balance after surgery.Level of Evidence4