Is Preoperative Cervical Kyphosis a Fixed Structural Deformity in Compressive Myelopathy? A Longitudinal Dynamic Radiographs Analysis
Seunghoon Lee, Joo Hong Joun, Chang-Hyun Lee, Jungbo Sim, Hangeul Park, Chi Heon KimBACKGROUND AND OBJECTIVES:
Conventional selection for cervical laminoplasty relies on the neutral-position C2-7 Cobb angle. Preoperative kyphosis is often considered a relative contraindication because of concerns regarding impaired spinal cord shift. However, this may reflect compensatory functional posture to minimize cord compression. We investigated preoperative kyphosis reversibility and the longitudinal cervical alignment changes after laminoplasty.
METHODS:
We retrospectively analyzed 850 consecutive patients undergoing cervical laminoplasty for myelopathy (2015-2023). Serial standing lateral radiographs in neutral, flexion, and extension positions were analyzed preoperatively through 5 years postoperatively (mean follow-up, 29.6 ± 27.7 months). Patients were stratified by preoperative alignment (lordosis, straight, and kyphosis) and diagnosis (cervical spondylotic myelopathy and cervical myelopathy with ossification of the posterior longitudinal ligament). The C2-7 Cobb angle, C7 slope, and C2-7 sagittal vertical axis were measured at each time point in all 3 positions.
RESULTS:
Overall, the neutral-position C2-7 angle showed no significant change immediately after laminoplasty (mean difference, 0.38°;
CONCLUSION:
Mild preoperative kyphosis of the cervical spine on neutral position may represent a potentially reversible condition rather than a fixed deformity. This aspect warrants careful consideration when selecting a posterior decompressive surgery.