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Neurospine > Volume 18(4); 2021 > Article
Son: Commentary on “Surgical and Functional Outcomes of Expansive Open-Door Laminoplasty for Patients With Mild Kyphotic Cervical Alignment”
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I read the article titled “Surgical and functional outcomes of expansive open-door laminoplasty for patients with mild kyphotic cervical alignment” [1] with interest that raised questions about the preoperative kyphotic alignment, which is a contraindication to laminoplasty. In the World Federation of Neurosurgical Society (WFNS) recommendation, preoperative straight or lordotic alignment is the candidate for laminoplasty, and anterior cervical discectomy and fusion (ACDF) or laminectomy and posterior fusion are recommended for kyphotic alignment for cervical spondylotic myelopathy (CSM) [2-6]. However, ACDF and posterior fusion are expected to have high complications in elderly patients with poor bone quality [7,8]. Clinically, there was a demand to expand laminoplasty to broader indications, such as mild kyphotic alignment. I read impressively the results of over 14 years of laminoplasty from the author's institution. They reported no significant differences in the final average recovery rates among those with different preoperative alignments in the CSM group, but patients with preoperative kyphosis in the OPLL (ossification of the posterior longitudinal ligament) group had much lower recovery rates than those with lordotic and straight alignments although statistical significance was not detected due to the small sample size [9]. However, in this study, the authors could find the efficacy of laminoplasty on mild kyphotic alignment in more cases. Recently, many dynamic concepts, not static concepts, have been presented in laminoplasty studies [10,11]. Now, we need to develop an extended indication that can be safely applied laminoplasty to more patients, rather than simply limiting mild kyphotic alignment as a contraindication. Dr Nagoshi and colleagues [1] well explained the tendency of mild kyphosis patients to change to a lordotic curve after laminoplasty and relatively good clinical results. These results may provide more options for the treatment of elderly osteoporotic and mild kyphosis patients. Lastly, as in the author’s conclusion, I fully agree with the phrase “laminoplasty is not all possible in mild kyphotic alignment patients.” We still need to pay attention to the severe postoperative kyphotic alignment that occurs after laminoplasty and make efforts to find an appropriate indication.

CONFLICT OF INTEREST

The author has nothing to disclose.

REFERENCES

1. Nagoshi N, Nori S, Tsuji O, et al. Surgical and functional outcomes of expansive open-door laminoplasty for patients with mild kyphotic cervical alignment. Neurospine 2021 18:749-57.
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2. Bajamal AH, Kim SH, Arifianto MR, et al. Posterior surgical techniques for cervical spondylotic myelopathy: WFNS Spine Committee Recommendations. Neurospine 2019 16:421-34.
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3. Deora H, Kim SH, Behari S, et al. Anterior surgical techniques for cervical spondylotic myelopathy: WFNS Spine Committee Recommendations. Neurospine 2019 16:408-20.
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4. Parthiban J, Alves OL, Chandrachari KP, et al. Value of surgery and nonsurgical approaches for cervical spondylotic myelopathy: WFNS Spine Committee Recommendations. Neurospine 2019 16:403-7.
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5. Zileli M. Recommendations of WFNS Spine Committee. Neurospine 2019 16:383-5.
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6. Zileli M, Borkar SA, Sinha S, et al. Cervical spondylotic myelopathy: natural course and the value of diagnostic techniques -WFNS Spine Committee Recommendations. Neurospine 2019 16:386-402.
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7. Lee CH, Son DW, Lee SH, et al. Radiological and clinical outcomes of anterior cervical discectomy and fusion in older patients: a comparative analysis of young-old patients (ages 65-74 years) and middle-old patients (over 75 years). Neurospine 2020 17:156-63.
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8. Umekawa M, Takai K, Taniguchi M. Complications of spine surgery in elderly japanese patients: implications for future of world population aging. Neurospine 2019 16:780-8.
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9. Chiba K, Ogawa Y, Ishii K, et al. Long-term results of expansive open-door laminoplasty for cervical myelopathy--average 14-year follow-up study. Spine (Phila Pa 1976) 2006 31:2998-3005.
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10. Joaquim AF, Baum GR, Tan LA, et al. Dynamic cord compression causing cervical myelopathy. Neurospine 2019 16:448-53.
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11. Ono K, Murata S, Matsushita M, et al. Cervical lordosis ratio as a novel predictor for the loss of cervical lordosis after laminoplasty. Neurospine 2021 18:311-8.
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