title: Effect of Preoperative Sagittal Balance on Cervical Laminoplasty Outcomes.
abstract: METHODS
  Retrospective case series.
  
  
  OBJECTIVE
  To clarify how preoperative global sagittal imbalance influences outcomes in patients with cervical compression myelopathy undergoing cervical laminoplasty.
  
  
  BACKGROUND
  The influence of sagittal balance on outcomes of cervical laminoplasty remains uncertain.
  
  
  METHODS
  The authors retrospectively reviewed data of 106 patients who underwent double-door cervical laminoplasty between 2004 and 2011 and investigated the influence of the C7 sagittal vertical axis (SVA) on outcome scores. Primary outcomes used were Japanese Orthopedic Association (JOA) scores, Numerical Rating Scale for neck or arm pain, the Short Form 36 Health Survey (physical and mental component summary scores ), and the Neck Disability Index (NDI).
  
  
  RESULTS
  Ninety-two patients with complete data were eligible for inclusion. The preoperative C7 SVA was ≤5 cm in 64 patients (69.6%) and > 5 cm in 28 (30.4%). We compared each parameter by the magnitude of spinal sagittal balance (preoperative C7 SVA > 5 cm vs. C7 SVA ≤ 5 cm) after adjusting for age via the least square mean analysis because the average age was significantly higher in patients with C7 SVA > 5 cm. As for the radiographic parameters, both C2-7 SVA and C7 SVA were larger in patients when the C7 SVA was > 5 cm. Numerical Rating Scale for postoperative arm pain, postoperative JOA scores, and both pre- and postoperative physical component summary and NDI were worse in patients with C7 SVA > 5 cm; however, the JOA score recovery rate and changes in physical component summary and NDI were not significantly different.
  
  
  CONCLUSIONS
  Postoperative functional outcome scores were significantly lower in patients with C7 SVA > 5 cm, although the improvement after cervical laminoplasty was not greatly affected. The involvement of global sagittal balance and cervical regional alignment should be considered in evaluating surgical outcomes for patients undergoing cervical laminoplasty.
  
  
  METHODS
  4.
authors.affiliation: Department of Orthopedic Surgery, University of Tokyo, Tokyo, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Oshima
authors.affiliation: Department of Orthopedics, Jichi Medical University.
authors.forename: Katsushi
authors.initials: K
authors.lastname: Takeshita
authors.affiliation: Department of Orthopedic Surgery, University of Tokyo, Tokyo, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Taniguchi
authors.affiliation: Department of Orthopedic Surgery, University of Tokyo, Tokyo, Japan.
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Matsubayashi
authors.affiliation: Department of Orthopedic Surgery, University of Tokyo, Tokyo, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Doi
authors.affiliation: Department of Orthopedic Surgery, University of Tokyo, Tokyo, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Ohya
authors.affiliation: Department of Orthopedic Surgery, University of Tokyo, Tokyo, Japan.
authors.forename: Kazuhito
authors.initials: K
authors.lastname: Soma
authors.affiliation: Department of Orthopedic Surgery, University of Tokyo, Tokyo, Japan.
authors.forename: So
authors.initials: S
authors.lastname: Kato
authors.affiliation: Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, The University of Tokyo.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Oka
authors.affiliation: Department of Orthopedic Surgery, University of Tokyo, Tokyo, Japan.
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Chikuda
authors.affiliation: Department of Orthopedic Surgery, University of Tokyo, Tokyo, Japan.
authors.forename: Sakae
authors.initials: S
authors.lastname: Tanaka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D065406:Laminoplasty; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D004856:Postural Balance / Q000502:physiology*; D011788:Quality of Life; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome