• Dong-Ho Lee, Sehan Park, Jae Hwan Cho, Chang Ju Hwang, Jae Jun Yang, and Choon Sung Lee.
• Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
• World Neurosurg. 2023 Dec 1; 180: e324e333e324-e333.

ObjectiveA retrospective cohort study was undertaken to elucidate the risk factors of loss of cervical lordosis (LCL), kyphotic deformity, and sagittal imbalance after cervical laminoplasty.MethodsA total of 108 patients who underwent laminoplasty to treat cervical myelopathy and were followed for ≥2 years were included. Logistic regression analysis and multiple regression analysis were performed to identify preoperative risk factors of LCL, kyphotic deformity (cervical lordosis <0°), and sagittal imbalance (sagittal vertical axis >40 mm) at postoperative 2 years.ResultsWithin multivariate multiple regression analysis, C2-C7 lordosis (P = 0.002), and C2-C7 extension capacity (P<0.001) showed significant association with LCL. Furthermore, age (P = 0.043) and C2-C7 lordosis (P = 0.038) were significantly associated with postoperative kyphosis. Receiver operating characteristic curve analysis for postoperative kyphosis showed that preoperative C2-C7 lordosis of 10.5° had a sensitivity and specificity of 81.3% and 82.4%, respectively. Preoperative K-line tilt (P = 0.034) showed a significant association with postoperative cervical sagittal imbalance at postoperative 2 years. Receiver operating characteristic curve analysis showed that a K-line tilt cutoff value of 12.5° had a sensitivity and specificity of 78.6% and 77.7%, respectively, for predicting postoperative sagittal imbalance.ConclusionsHigher preoperative C2-C7 lordosis and less preoperative cervical extension capacity were risk factors of LCL. Small preoperative C2-C7 lordosis <10.5° and younger age were risk factors of postoperative kyphosis. Furthermore, a greater K-line tilt would increase the risk of postoperative sagittal imbalance, with a cutoff value of 12.5°.Copyright © 2023 Elsevier Inc. All rights reserved.

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