• Hsuan-Yu Chen, Min-Hui Yang, Yen-Po Lin, Feng-Huei Lin, Po-Quang Chen, Ming-Hsiao Hu, and Shu-Hua Yang.
• Department of Orthopedics, National Taiwan University College of Medicine and National Taiwan University Hospital, No. 7, Chung-Shan South Road, Zhong-Zheng District, Taipei City, 100, Taiwan.
• Eur Spine J. 2020 May 1; 29 (5): 1052-1060.

PurposeNo standard strategy exists for managing cervical spondylotic myelopathy (CSM). The efficacy of spinous process-splitting laminoplasty, its impact on cervical alignment change and the incidence of postoperative neck pain remain unclear. We analyzed the parameters of cervical alignment and cord morphology in CSM.MethodsThe radiographic parameters investigated were pre- and postoperative C2-C7 lordosis (CL), C2-C7 sagittal vertical axis (CSVA), T1 slope (TS), TS minus CL (TS - CL) and cervical spinal cord morphology. Myelopathy severity was measured using two different functional scores. Statistical analysis was performed to determine significant differences between preoperative and follow-up radiological findings and change in functional scores.ResultsThis retrospective study comprised 85 CSM patients from a single institute, with a minimum follow-up of 24 months. Overall, 63.5% (n = 54) of patients had improvement in their postoperative cervical lordotic alignment; 36.5% (n = 31) developed progressive aggravation of the cervical kyphotic alignment. Pearson correlation analysis showed that CSVA, TS and T1-CL were independent predictors of CL curve change. Based on the receiver operating characteristic curve, the cutoff value for CSVA was 2.89 cm with a postoperative visual analog scale (VAS) > 4. The cutoff value of the TS - CL was 20 degrees with a postoperative VAS > 4. CSVA, TS and TS - CL had a significant association with variation in CL. CSVA and TS - CL had a significant association with postoperative neck pain.ConclusionsCSVA, T1 slope and T1-CL are good predictors of postoperative degenerative kyphotic change and neck pain. Careful consideration of their preoperative cutoff values can improve postoperative outcomes.Level Of EvidenceIV. These slides can be retrieved under Electronic Supplementary Material.

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