Preoperative Factors Affecting Postoperative Axial Symptoms After Single-Door Cervical Laminoplasty for Cervical Spondylotic Myelopathy: A Prospective Comparative Study

BACKGROUND Postoperative axial symptoms (post-AS) after single-door cervical laminoplasty for cervical spondylotic myelopathy (CSM) are a common and severe complication that adversely affects normal daily activities. Their etiology remains unclear. It is important to know which preoperative factors are the most predictive of post-AS. Therefore, this study aimed to elucidate the preoperative factors affecting post-AS. MATERIAL AND METHODS A total of 102 patients with CSM who underwent single-door cervical laminoplasty between 2009 and 2015 were studied. According to operation date, patients were prospectively assigned to treatment with conventional laminoplasty (CL) or modified laminoplasty (ML). Preoperative clinical and radiological parameters were recorded. The incidence of post-AS with 2 procedures was compared prospectively. Multivariate analysis was used to determine the preoperative factors affecting post-AS. RESULTS The incidence of post-AS after ML was significantly lower than after CL (P=0.010). ML and preoperative cervical C2-7 Cobb angle (CCA) were significant protective factors against post-AS (ML: P=0.011, odds ratio=0.302; CCA: P=0.042, odds ratio=0.947). Patients with post-AS had a lower preoperative CCA than patients without post-AS (P=0.043). The other preoperative factors were not significantly associated with post-AS. CONCLUSIONS The results of this study suggest that choosing ML procedure or selecting patients with high preoperative CCA can reduce the incidence of post-AS after single-door cervical laminoplasty for CSM, and that the other preoperative clinical or radiological parameters are less critical.