European Spine Journal

, Volume 26, Issue 4, pp 1205–1210 | Cite as

Predictors of cervical lordosis loss after laminoplasty in patients with cervical spondylotic myelopathy

  • Jing Tao Zhang
  • Jia Qi Li
  • Rui Jie Niu
  • Zhao Liu
  • Tong Tong
  • Yong ShenEmail author
Original Article



To determine whether radiological, clinical, and demographic findings in patients with cervical spondylotic myelopathy (CSM) were independently associated with loss of cervical lordosis (LCL) after laminoplasty.


The prospective study included 41 consecutive patients who underwent laminoplasty for CSM. The difference in C2-7 Cobb angle between the postoperative and preoperative films was used to evaluate change in cervical alignment. Age, sex, body mass index (BMI), smoking history, preoperative C2-7 Cobb angle, T1 slope, C2-7 range of motion (C2-7 ROM), C2-7 sagittal vertical axis (C2-7 SVA), and cephalad vertebral level undergoing laminoplasty (CVLL) were assessed. Data were analyzed using Pearson and Spearman correlation test, and univariate and stepwise multivariate linear regression.


T1 slope, C2-7 SVA, and CVLL significantly correlated with LCL (P < 0.001), whereas age, BMI, and preoperative C2-7 Cobb angle did not. In multiple linear regression analysis, higher T1 slope (B = 0.351, P = 0.037), greater C2-7 SVA (B = 0.393, P < 0.001), and starting laminoplasty at C4 level (B = − 7.038, P < 0.001) were significantly associated with higher postoperative LCL.


Cervical alignment was compromised after laminoplasty in patients with CSM, and the degree of LCL was associated with preoperative T1 slope, C2-7 SVA, and CVLL.


Cervical spondylotic myelopathy Kyphotic alignment change Kyphosis Laminoplasty Lordosis Sagittal alignment Sagittal balance 



We thank Dr. Jie Li for his assistance in the statistical analysis.

Compliance with ethical standards

Conflicts of interest

The author(s) declare that they have no competing interests.


  1. 1.
    Kimura I, Shingu H, Nasu Y (1995) Long-term follow-up of cervical spondylotic myelopathy treated by canal-expansive laminoplasty. J Bone Jt Surg Br 77(6):956–961Google Scholar
  2. 2.
    Suda K, Abumi K, Ito M et al (2003) Local kyphosis reduces surgical outcomes of expansive open-door laminoplasty for cervical spondylotic myelopathy. Spine (Phila Pa 1976) 28(12):1258–1262Google Scholar
  3. 3.
    Aita I, Wadano Y, Yabuki T (2000) Curvature and range of motion of the cervical spine after laminaplasty. J Bone Jt Surg Am 82(12):1743–1748CrossRefGoogle Scholar
  4. 4.
    Baba H, Uchida K, Maezawa Y et al (1996) Lordotic alignment and posterior migration of the spinal cord following en bloc open-door laminoplasty for cervical myelopathy: a magnetic resonance imaging study. J Neurol 243(9):626–632CrossRefPubMedGoogle Scholar
  5. 5.
    Taniyama T, Hirai T, Yoshii T et al (2014) Modified K-line in magnetic resonance imaging predicts clinical outcome in patients with nonlordotic alignment after laminoplasty for cervical spondylotic myelopathy. Spine (Phila Pa 1976) 39(21):E1261–E1268CrossRefGoogle Scholar
  6. 6.
    Suk KS, Kim KT, Lee JH et al (2007) Sagittal alignment of the cervical spine after the laminoplasty. Spine (Phila Pa 1976) 32(23):E656–E660CrossRefGoogle Scholar
  7. 7.
    Kim TH, Lee SY, Kim YC, Park MS, Kim SW (2013) T1 slope as a predictor of kyphotic alignment change after laminoplasty in patients with cervical myelopathy. Spine (Phila Pa 1976) 38(16):E992–E997CrossRefGoogle Scholar
  8. 8.
    Michael KW, Neustein TM, Rhee JM (2016) Where should a laminoplasty start? The effect of the proximal level on post-laminoplasty loss of lordosis. Spine J 16(6):737–741CrossRefPubMedGoogle Scholar
  9. 9.
    Machino M, Yukawa Y, Hida T et al (2012) Cervical alignment and range of motion after laminoplasty: radiographical data from more than 500 cases with cervical spondylotic myelopathy and a review of the literature. Spine (Phila Pa 1976) 37(20):E1243–E1250CrossRefGoogle Scholar
  10. 10.
    Yukawa Y, Kato F, Ito K et al (2007) Laminoplasty and skip laminectomy for cervical compressive myelopathy: range of motion, postoperative neck pain, and surgical outcomes in a randomized prospective study. Spine (Phila Pa 1976) 32(18):1980–1985CrossRefGoogle Scholar
  11. 11.
    Fujimura Y, Nishi Y (1996) Atrophy of the nuchal muscle and change in cervical curvature after expansive open-door laminoplasty. Arch Orthop Trauma Surg 115(3–4):203–205CrossRefPubMedGoogle Scholar
  12. 12.
    Kawaguchi Y, Kanamori M, Ishihara H et al (2003) Minimum 10-year followup after en bloc cervical laminoplasty. Clin Orthop Relat Res 411:129–139CrossRefGoogle Scholar
  13. 13.
    Ratliff JK, Cooper PR (2003) Cervical laminoplasty: a critical review. J Neurosurg 98(3 Suppl):230–238PubMedGoogle Scholar
  14. 14.
    Tang JA, Scheer JK, Smith JS et al (2012) The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery. Neurosurgery 71(3):662–669 (discussion 669) CrossRefPubMedGoogle Scholar
  15. 15.
    Sakai K, Yoshii T, Hirai T et al (2016) Impact of the surgical treatment for degenerative cervical myelopathy on the preoperative cervical sagittal balance: a review of prospective comparative cohort between anterior decompression with fusion and laminoplasty. Eur Spine J (Epub ahead of print)Google Scholar
  16. 16.
    Kim B, Yoon DH, Ha Y et al (2016) Relationship between T1 slope and loss of lordosis after laminoplasty in patients with cervical ossification of the posterior longitudinal ligament. Spine J 16(2):219–225CrossRefPubMedGoogle Scholar
  17. 17.
    Ames CP, Blondel B, Scheer JK et al (2013) Cervical radiographical alignment: comprehensive assessment techniques and potential importance in cervical myelopathy. Spine (Phila Pa 1976) 38(22 Suppl 1):S149–S160CrossRefGoogle Scholar
  18. 18.
    Sakai K, Yoshii T, Hirai T et al (2016) Cervical sagittal imbalance is a predictor of kyphotic deformity after laminoplasty in cervical spondylotic myelopathy patients without preoperative kyphotic alignment. Spine (Phila Pa 1976) 41(4):299–305CrossRefGoogle Scholar
  19. 19.
    Cho JH, Ha JK, Kim DG et al (2014) Does preoperative T1 slope affect radiological and functional outcomes after cervical laminoplasty? Spine (Phila Pa 1976) 39(26):E1575–E1581CrossRefGoogle Scholar
  20. 20.
    Iizuka H, Shimizu T, Tateno K et al (2001) Extensor musculature of the cervical spine after laminoplasty: morphologic evaluation by coronal view of the magnetic resonance image. Spine (Phila Pa 1976) 26(20):2220–2226CrossRefGoogle Scholar
  21. 21.
    Lin S, Zhou F, Sun Y et al (2015) The severity of operative invasion to the posterior muscular-ligament complex influences cervical sagittal balance after open-door laminoplasty. Eur Spine J 24(1):127–135CrossRefPubMedGoogle Scholar
  22. 22.
    Iizuka H, Nakajima T, Iizuka Y et al (2007) Cervical malalignment after laminoplasty: relationship to deep extensor musculature of the cervical spine and neurological outcome. J Neurosurg Spine 7(6):610–614CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Jing Tao Zhang
    • 1
  • Jia Qi Li
    • 1
  • Rui Jie Niu
    • 1
  • Zhao Liu
    • 1
  • Tong Tong
    • 1
  • Yong Shen
    • 1
    Email author
  1. 1.Department of Spinal SurgeryThe Third Hospital of Hebei Medical UniversityShijiazhuangPeople’s Republic of China

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