Cervical kyphosis after posterior cervical laminectomy with and without fusion

• Published in: European spine journal 2024-08, Vol.33 (8), p.3109-3116
• Main Authors: Jentzsch, Thorsten, Wetzel, Oliver T., Malhotra, Armaan K., Lozano, Christopher S., Massicotte, Eric M., Spirig, José M., Fehlings, Michael G., Farshad, Mazda
• Format: Article
• Language: English
• Subjects: Aged; Central nervous system diseases; Cervical Vertebrae - diagnostic imaging; Cervical Vertebrae - surgery; Cohort analysis; Comparative analysis; Female; Hospitals; Humans; Kyphosis; Kyphosis - diagnostic imaging; Kyphosis - etiology; Kyphosis - surgery; Laminectomy - adverse effects; Laminectomy - methods; Male; Medicine; Medicine & Public Health; Middle Aged; Neurosurgery; Original Article; Orthopedics; Postoperative Complications - diagnostic imaging; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Regression analysis; Retrospective Studies; Spinal cord; Spinal Cord Diseases - diagnostic imaging; Spinal Cord Diseases - etiology; Spinal Cord Diseases - surgery; Spinal Fusion - adverse effects; Spinal Fusion - methods; Surgeons; Surgery; Surgical Orthopedics; Treatment Outcome
• ISSN: 0940-6719; 1432-0932; 1432-0932
• DOI: 10.1007/s00586-024-08260-3

Background Cervical posterior instrumentation and fusion is often performed to avoid post-laminectomy kyphosis. However, larger comparative analyses of cervical laminectomy with or without fusion are sparse. Methods A retrospective, two-center, comparative cohort study included patients after stand-alone dorsal laminectomy with (n = 91) or without (n = 46) additional fusion for degenerative cervical myelopathy with a median follow-up of 59 (interquartile range (IQR) 52) months. The primary outcome was the C2-7 Cobb angle and secondary outcomes were Neck Disability Index (NDI), modified Japanese Orthopaedic Association (mJOA) scale, revision rates, T1 slope and C2-7 sagittal vertical axis (C2-7 SVA) at final follow-up. Logistic regression analysis adjusted for potential confounders (i.e. age, operated levels, and follow-up). Results: Preoperative C2-7 Cobb angle and T1 slope were higher in the laminectomy group, while the C2-7 SVA was similar. The decrease in C2-7 Cobb angle from pre- to postoperatively was more pronounced in the laminectomy group (− 6° (IQR 20) versus −1° (IQR 7), p  = 0.002). When adjusting for confounders, the decrease in C2-7 Cobb angle remained higher in the laminectomy group (coefficient − 12 (95% confidence interval (CI) −18 to −5), p  = 0.001). However, there were no adjusted differences for postoperative NDI (− 11 (− 23 to 2), p  = 0.10), mJOA, revision rates, T1 slope and C2-7 SVA. Conclusion: Posterior cervical laminectomy without fusion is associated with mild loss of cervical lordosis of around 6° in the mid-term after approximately five years, however without any clinical relevance regarding NDI or mJOA in well-selected patients (particularly in shorter segment laminectomies of