• World Neurosurg · Feb 2021

    The effects of the preservation of the semispinalis cervicis inserted into C2 on cranio-cervical alignment after laminoplasty.

    • Kiyoharu Shimizu, Takafumi Mitsuhara, Masaaki Takeda, Kaoru Kurisu, and Satoshi Yamaguchi.
    • Departments of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan. Electronic address: shimizu.kiyoharu@gmail.com.
    • World Neurosurg. 2021 Feb 1; 146: e1367-e1376.

    ObjectiveThe preservation of nuchal musculature is essential for preventing axial pain and cervical malalignment after laminoplasty. A few studies have examined the effect of preservation of nuchal musculature on the degenerative progression after laminoplasty. We aimed to clarify the influence of preservation of the semispinalis cervicis inserted into C2 on cervical degenerative change and alignment after laminoplasty.MethodsWe retrospectively reviewed 106 consecutive patients who underwent C3-7 laminoplasty for cervical spondylotic myelopathy during 2006-2017. Patients were classified into 2 groups according to the preservation (P-group; n = 33) or detachment (D-group; n = 73) of the Semispinalis cervicis muscles inserted into the C2 spinous process. Parameters of cervical sagittal alignment, range of motion, and progressive degenerative changes next to or within the range of laminoplasty were evaluated in cervical spine radiographs, and magnetic resonance images obtained during follow-up period.ResultsIn the D-group, the postoperative C2-7 Cobb angle significantly decreased (-0.06°/month), while the O-C2 Cobb angle significantly increased (0.07°/month). In addition, the C2-7 range of motion significantly decreased in the D-group (-0.12°/month). Degenerative changes in the laminoplasty range were found in 5 patients per group. Three patients from the D-group developed retroodontoid pseudotumors (P < 0.001).ConclusionsTo maintain horizontal gaze, the craniocervical segment can compensate for the loss of lordosis by increasing the Cobb angle. Excessive compensation may exert mechanical stress on the atlantoaxial junction, contributing to the development of a retroodontoid pseudotumor. Preservation of the semispinalis cervicis inserted into C2 is critical for the prevention of malalignment after laminoplasty.Copyright © 2020 Elsevier Inc. All rights reserved.

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