Elsevier

World Neurosurgery

Volume 107, November 2017, Pages 445-450
World Neurosurgery

Original Article
Cervical Paraspinal Muscle Atrophy Rates Following Laminoplasty and Laminectomy with Fusion for Cervical Spondylotic Myelopathy

https://doi.org/10.1016/j.wneu.2017.07.173Get rights and content

Background

Cervical spondylotic myelopathy (CSM) is a disorder that can cause neurologic deterioration. Studies on paraspinal muscular atrophy (PMA) in the lumbar spine have shown that these changes are caused by several perioperative factors. It is possible that PMA in the cervical spine could behave similarly. 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.

Methods

18 laminoplasty and 43 LF patients were included in this study. For each patient, preoperative and postoperative MRI files were obtained and transferred into OsiriX imaging software. Atrophy rate was obtained and reported as percentage change in cross-sectional area of the cervical paraspinal muscles from preoperative to postoperative imaging.

Results

Mean cross-sectional cervical muscle atrophy rates were 6% and 13.1% for laminoplasty and LF, respectively, representing a 2.19 times increase in the degree of atrophy (P < 0.001). Independently, LF was associated with a 5.84% increase in the rate of PMA (P = 0.03). Involvement of C3 as the cephalad surgical level was associated with a 5.78% decrease in the rate of PMA (P = 0.03). For each degree increase in postoperative Cobb angle, there was a 0.66% decrease in the rate of PMA (P = 0.02).

Conclusion

PMA should be part of the decision making process when a posterior approach is considered, inasmuch as this study demonstrates that cervical laminoplasty was associated with significantly lower rates of PMA compared with cervical laminectomy and fusion. Additionally, these results suggest that minimizing PMA may help preserve cervical lordosis.

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

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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.

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