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Document Type

Original Study

Abstract

Background Data: Degenerative cervical myelopathy (DCM) is the leading cause of spinal cord dysfunction among the elder group of the population. DCM is a degenerative disease that slowly progresses with time; in addition, moderate-to-severe symptomatic patients usually require decompression surgery to relieve the compressed cord. Posterior cervical laminectomy (PCL) without fusion is a known and commonly practiced surgical procedure for multiple levels of DCM. Concerns were raised for the post-PCL without fusion kyphosis as a sequel to laminectomy, as several authors reported the occurrence of post-PCL without fusion kyphosis, which may be reflected in the clinical and radiological outcome. Purpose: This study aims to study the cervical spine sagittal alignment post-PCL without fusion and correlate this to preoperative radiological parameters. Study Design: Retrospective analytical cohort study. Patients and Methods: The surgical database of our institution hospital was used to retrieve the data of DCM patients who underwent PCL (C3–C6) without fusion. Demographic data of the patients were reported and analyzed. The radiological evaluation used the Cobb angle from C2 to C7 on lateral cervical X-ray, and a comparison between pre- ad postoperative angles was analyzed. The sagittal vertical axis “cSVA” of C2-C7 and C7 slope angles were measured. All measurements were done using Surgimap v2.3 (Nemaris, New York, USA). Results: Total number of patients was 48 after 24 months, the Cobb angle increased from 22.02±14.4 to 22.24±9.121(p=0.304), the cSVA increased significantly from 14.32±10.3 to 18.25±11.46 (p=0.013), and the C7 slope angle increased from 27.84±11.35 to 29.18±6.95 (p=0.649). Only 14 patients (29.1%) had their cervical Cobb angle decreased after 24 months. Both C2-C7 Cobb and C7 slope angles correlated to the decreased cervical Cobb angle after 24 months. Conclusion: Preoperative cervical Cobb angle and C7 slope angle may correlate to the decreased postoperative cervical Cobb angle. In light of the study findings, it is recommended that long-term follow-ups of PCL without fusion surgeries are very crucial to truly reflect the natural senile process effects on the cervical sagittal balance.

Keywords

degenerative cervical myelopathy, posterior cervical laminectomy, cervical kyphosis, cervical Cobb angle, sagittal alignment.

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