Original ArticleCervical Paraspinal Muscle Atrophy Rates Following Laminoplasty and Laminectomy with Fusion for Cervical Spondylotic Myelopathy
Introduction
Cervical spondylotic myelopathy (CSM) is a debilitating disorder that can potentially cause significant and progressive neurologic deterioration. CSM remains the leading cause of spinal cord pathologic conditions worldwide.1 Surgery is the standard of care for progressive CSM, and a posterior approach is frequently used in the management of multilevel disease in the absence of rigid cervical kyphosis.2 However, atrophy of the paraspinal musculature after the posterior approach is common after spinal surgery.3 Studies on paraspinal muscular atrophy (PMA) in the lumbar spine have shown that these changes are caused by mechanical injury, ischemia, denervation, retraction time, a midline approach, and disuse secondary to bracing.4, 5, 6, 7, 8, 9 PMA has been shown to lead to poor outcomes after lumbar spine surgery, contributing to postoperative pain, instability, and failed back syndrome.3
Comparatively fewer studies have investigated PMA in the cervical spine, but the available research suggests that limiting exposure to the medial two thirds of the lateral masses may decrease PMA.10 More importantly, there is a scarcity of literature comparing the relative impact of different posterior procedures on cervical PMA. The authors of this study postulate that the choice of procedure could alter the incidence of PMA. In this retrospective study, we compared the degree of PMA after laminoplasty versus laminectomy and fusion (LF) using a standard posterior approach to the cervical spine.
Section snippets
Methods
The study was reviewed and approved by the institutional review board at our institution. The medical records, preoperative and postoperative radiographs, and magnetic resonance imaging (MRI) of the cervical spine were reviewed on all patients undergoing laminoplasty or LF by the senior author at more than 1 consecutive level for CSM between 2006 and 2015. Significant kyphosis and instability were contraindications to laminoplasty, and fixed severe kyphosis was a contraindication for LF.
Demographic and Clinical Data
The laminoplasty group (n = 18) had a mean age of 54.5 ± 9.4 years (range, 42–77 years), with a mean number of surgical levels of 3.1 ± 1.13, whereas the LF group (n = 43) had a mean age of 65 ± 10.2 years (range, 38–89 years), with a mean number of surgical levels of 3.5 ± 1.16 (age, P < 0.001; levels, P = 0.22) (Table 1).
Radiographic Analysis
The mean interval time from surgery to postoperative MRI in groups A (laminoplasty group) and B (LF group) were 12.3 months and 11 months, respectively (P = 0.74). The mean
Discussion
Laminoplasty and LF are the 2 most common posterior procedures used to address cervical spondylotic myelopathy.12, 13, 14 However, these procedures use a posteromedial approach to the cervical spine, which has shown to lead to PMA and poor clinical outcomes in the lumbar spine in some cases.3, 4, 5, 6, 7, 8, 9 Possible causes may include mechanical injury, ischemia, disuse, and denervation.3, 15 Several theories of the pathophysiology of PMA have been proposed. In multiple animal studies,
Conclusion
This study demonstrates that cervical laminoplasty was associated with significantly lower rates of PMA compared with cervical LF. In addition, a correlation was found between PMA and loss of postoperative sagittal alignment. These results suggest that minimizing PMA may help preserve cervical alignment by maintaining cervical lordosis, as previously described.22, 11 Given these findings, we believe the potential for PMA should be part of the decision-making process when a posterior approach is
References (28)
- et al.
Technique to minimize paraspinal muscle atrophy after posterior cervical fusion
Clin Neurol Neurosurg
(2011) - et al.
Correlation between the MRI changes in the lumbar multifidus muscles and leg pain
Clin Radiol
(2000) - et al.
Cervical spondylotic myelopathy: current state of the art and future directions
Spine
(2013) - et al.
Local kyphosis reduces surgical outcomes of expansive open-door laminoplasty for cervical spondylotic myelopathy
Spine
(2003) - et al.
Local denervation atrophy of paraspinal muscles in postoperative failed back syndrome
Spine
(1993) - et al.
Danger of damaging the medial branches of the posterior rami of spinal nerves during a dorsomedian approach to the spine
Clin Anat
(2002) - et al.
Back pain and disability after lumbar laminectomy: is there a relationship to muscle retraction?
Neurosurgery
(2004) - et al.
Rapid atrophy of the lumbar multifidus follows experimental disc or nerve root injury
Spine
(2006) - et al.
Postoperative changes in paraspinal muscle volume: comparison between paramedian interfascial and midline approaches for lumbar fusion
J Korean Med Sci
(2007) - et al.
Postoperative change of the cross-sectional area of back musculature after 5 surgical procedures as assessed by magnetic resonance imaging
J Spinal Disord Tech
(2006)
Postoperative changes in paraspinal muscle thickness after various lumbar back surgery procedures
Neurol Med Chir
Paraspinal muscle morphometry in cervical spondylotic myelopathy and its implications in clinicoradiological outcomes following central corpectomy: clinical article
J Neurosurg Spine
Cervical laminoplasty for the treatment of cervical degenerative myelopathy
J Neurosurg Spine
Laminectomy and fusion for the treatment of cervical degenerative myelopathy
J Neurosurg Spine
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Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.