Clinical Impact of Cervical Imbalance on Surgical Outcomes of Laminoplasty: A Propensity Score-Matching Analysis.
Journal
Clinical spine surgery
ISSN: 2380-0194
Titre abrégé: Clin Spine Surg
Pays: United States
ID NLM: 101675083
Informations de publication
Date de publication:
02 2020
02 2020
Historique:
pubmed:
5
6
2019
medline:
24
10
2020
entrez:
5
6
2019
Statut:
ppublish
Résumé
This is a retrospective cohort study. The objective of this study was to identify the impact of preoperative cervical sagittal balance on the 2-year surgical outcomes of laminoplasty. The cervical imbalance is considered associated with poor health-related quality of life and poor outcomes for cervical deformity surgery. However, the influences of cervical imbalance on the clinical outcomes of laminoplasty for cervical spondylotic myelopathy (CSM) patients are unclear. A total of 277 consecutive CSM patients who underwent laminoplasty were analyzed. From the last consecutive 136 patients, matched control group [cervical sagittal vertical axis (cSVA)<40 mm, n=30] and matched imbalance group (≥40 mm, n=30) were selected based on their propensity score adjusted for age, sex, cervical alignment, and preoperative Japanese Orthopaedic Association (JOA) score. Change in clinical outcomes and radiographic parameters at 2 years postoperatively were compared between the 2 matched groups using mixed-effects model. For the validation of the primary results, factors that correlated with the recovery rate of JOA score of another 141 patients were analyzed using multiple linear regression analysis. There was no significant interaction between the 2 matched groups in all clinical outcomes, including the severity of myelopathy, patient-oriented health-related quality of life score, physical and mental status, physical functions, and pain score. Regarding the radiographic evaluation, change in cSVA showed significant differences (P=0.038); cSVA was kept stable in the matched control group, whereas its value significantly decreased in the matched imbalance group. Multiple linear regression models demonstrated that preoperative cSVA is not significantly related to the recovery rate of JOA score at 2 years postoperatively (P=0.114). Preoperative cervical imbalance did not significantly affect the 2-year surgical outcomes of laminoplasty. Furthermore, cervical imbalance improved after surgery. These results can suggest physicians consider laminoplasty as a treatment for CSM patients regardless of their cervical balance. Level III-treatment benefits: nonrandomized controlled cohort/follow-up study.
Sections du résumé
STUDY DESIGN
This is a retrospective cohort study.
OBJECTIVE
The objective of this study was to identify the impact of preoperative cervical sagittal balance on the 2-year surgical outcomes of laminoplasty.
SUMMARY OF BACKGROUND DATA
The cervical imbalance is considered associated with poor health-related quality of life and poor outcomes for cervical deformity surgery. However, the influences of cervical imbalance on the clinical outcomes of laminoplasty for cervical spondylotic myelopathy (CSM) patients are unclear.
MATERIALS AND METHODS
A total of 277 consecutive CSM patients who underwent laminoplasty were analyzed. From the last consecutive 136 patients, matched control group [cervical sagittal vertical axis (cSVA)<40 mm, n=30] and matched imbalance group (≥40 mm, n=30) were selected based on their propensity score adjusted for age, sex, cervical alignment, and preoperative Japanese Orthopaedic Association (JOA) score. Change in clinical outcomes and radiographic parameters at 2 years postoperatively were compared between the 2 matched groups using mixed-effects model. For the validation of the primary results, factors that correlated with the recovery rate of JOA score of another 141 patients were analyzed using multiple linear regression analysis.
RESULTS
There was no significant interaction between the 2 matched groups in all clinical outcomes, including the severity of myelopathy, patient-oriented health-related quality of life score, physical and mental status, physical functions, and pain score. Regarding the radiographic evaluation, change in cSVA showed significant differences (P=0.038); cSVA was kept stable in the matched control group, whereas its value significantly decreased in the matched imbalance group. Multiple linear regression models demonstrated that preoperative cSVA is not significantly related to the recovery rate of JOA score at 2 years postoperatively (P=0.114).
CONCLUSIONS
Preoperative cervical imbalance did not significantly affect the 2-year surgical outcomes of laminoplasty. Furthermore, cervical imbalance improved after surgery. These results can suggest physicians consider laminoplasty as a treatment for CSM patients regardless of their cervical balance.
LEVEL OF EVIDENCE
Level III-treatment benefits: nonrandomized controlled cohort/follow-up study.
Identifiants
pubmed: 31162189
doi: 10.1097/BSD.0000000000000849
pii: 01933606-202002000-00008
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
E1-E7Références
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