title: Outcomes of surgical intervention for cervical spondylotic myelopathy accompanying local kyphosis (comparison between laminoplasty alone and posterior reconstruction surgery using the screw-rod system).
abstract: OBJECTIVE
  The surgical strategy for cervical spondylotic myelopathy (CSM) accompanying local kyphosis is controversial. The purpose of the present study was to compare and evaluate the outcomes of two types of surgery for CSM accompanying local kyphosis: (1) laminoplasty alone (LP) and (2) posterior reconstruction surgery (PR) in which we corrected the local kyphosis using a pedicle screw or lateral mass screw.
  
  
  METHODS
  Sixty patients who presented with local kyphosis exceeding 5° were enrolled. LP and PR were each performed on a group of 30 of these patients; 30 CSM patients without local kyphosis, who had undergone LP, were used as controls. The follow-up period was 2 years or longer. Preoperative local kyphosis angles in LP and PR were 8.3° ± 4.4° and 8.8° ± 5.7°, respectively. Preoperative C2-7 angles in LP, PR and controls were -1.7° ± 9.6°, -0.4° ± 7.2° and -12.0° ± 5.6°, respectively. The recovery rate of the JOA score, local kyphosis angle and C2-7 angle at post-op and follow-up were compared between the groups.
  
  
  RESULTS
  The recovery rate of the JOA score in the LP group (32.6 %) was significantly worse than that in the PR group (44.5 %) and that of controls (53.8 %). Local kyphosis angles in the PR and LP groups at follow-up were 4.0° ± 8.6° and 8.0° ± 6.0°, respectively. However, although the C2-7 angle at follow-up was improved to -11.1° ± 12.7° in PR, and maintained at -11.6° ± 6.2° in controls, it deteriorated to 0.5° ± 12.7° in LP.
  
  
  CONCLUSIONS
  The present study is the first to compare the outcomes between LP alone and PR for CSM accompanying local kyphosis. It revealed that PR resulted in a better clinical outcome than did LP alone. This result may be due to reduction of local kyphosis, stabilization of the unstable segment, and/or the maintenance of C2-7 angle until follow-up in the PR group.
authors.affiliation: Department of Orthopaedic Surgery, Kinki University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan, hiroshimiyamoto@hotmail.com.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Miyamoto
authors.forename: Koichiro
authors.initials: K
authors.lastname: Maeno
authors.forename: Koki
authors.initials: K
authors.lastname: Uno
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Kakutani
authors.forename: Kotaro
authors.initials: K
authors.lastname: Nishida
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Sumi
mesh_terms: D000368:Aged; D001863:Bone Screws; D002574:Cervical Vertebrae / Q000601:surgery*; D005260:Female; D006801:Humans; D007738:Kyphosis / Q000601:surgery*; D065406:Laminoplasty / Q000009:adverse effects / Q000379:methods*; D008297:Male; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D055009:Spondylosis / Q000601:surgery*; D016896:Treatment Outcome
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