title: Preservation of the nuchal ligament plays an important role in preventing unfavorable radiologic changes after laminoplasty.
abstract: METHODS
  Prospective study.
  
  
  OBJECTIVE
  To examine whether preservation of the funicular section of the nuchal ligament attached to the C6 and C7 spinous processes could prevent unfavorable radiologic changes such as kyphotic deformity and destabilization at the C6/7 segment, and to investigate possible correlations between adverse radiologic changes and neurologic recovery or incidence of axial neck pain after laminoplasty in patients with cervical spondylotic myelopathy.
  
  
  BACKGROUND
  Adverse radiologic changes after cervical laminoplasty have been reported to result from detachment of cervical extensor muscles.
  
  
  METHODS
  Subjects comprised 37 patients who underwent modified C3-6 laminoplasty. Our procedure preserves the funicular section of the nuchal ligament attached to the C6 and/or C7 spinous processes in addition to all muscles attached to the C2 and C7 spinous processes and the subaxial deep extensor muscles on the hinged side. The funicular section of the ligament attached only to the C7 spinous process was preserved in 18 patients (C7 group). This funicular section attaching both to the C7 and C6 spinous processes was preserved in 19 patients (C6+7 group). Radiologic and clinical data were prospectively collected.
  
  
  RESULTS
  Postoperative loss of lordosis and destabilization at the C6/7 segment were significantly reduced in the C6+7 group compared with the C7 group. As of final follow-up, neurologic recovery was significantly poorer in the 3 patients with kyphosis than in the 34 patients with straight spinal alignment or lordosis. Frequencies of axial pain showed no significant differences between groups. This value did not vary with the differences in sagittal alignment.
  
  
  CONCLUSIONS
  These results indicate that the preserved funicular section of the nuchal ligament attached both to the C6 and C7 spinous processes plays an important role in preventing undesirable radiologic changes after laminoplasty.
authors.affiliation: Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, Suita, Japan. sakaurah@ort.med.osaka-u.ac.jp
authors.forename: Hironobu
authors.initials: H
authors.lastname: Sakaura
authors.forename: Noboru
authors.initials: N
authors.lastname: Hosono
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Mukai
authors.forename: Kazuya
authors.initials: K
authors.lastname: Oshima
authors.forename: Motoki
authors.initials: M
authors.lastname: Iwasaki
authors.forename: Hideki
authors.initials: H
authors.lastname: Yoshikawa
mesh_terms: D000368:Aged; D001696:Biomechanical Phenomena; D002574:Cervical Vertebrae / Q000033:anatomy & histology / Q000473:pathology / Q000601:surgery*; D005260:Female; D019416:Head Movements / Q000502:physiology; D006801:Humans; D007738:Kyphosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D007796:Laminectomy / Q000009:adverse effects* / Q000379:methods* / Q000592:standards; D008022:Ligaments / Q000033:anatomy & histology / Q000293:injuries / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D011446:Prospective Studies; D011843:Radiculopathy / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D013117:Spinal Cord Compression / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D013128:Spinal Osteophytosis / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome