Cervical malalignment after laminoplasty: relationship to deep extensor musculature of the cervical spine and neurological outcome.

Object: The goal of this study was to investigate the relationship between preservation of the insertion of the deep extensor musculature of the cervical spine at C-2 and postoperative cervical alignment, especially differences between cases involving male and female patients, as well as the relationship between the loss of cervical lordosis and neurological outcome after laminoplasty.

Methods: The authors reviewed the records of 50 patients who underwent laminoplasty to elevate the C-3 lamina with repair of the deep extensor musculature (Group A) and 31 patients who underwent laminoplasty by C-3 dome laminotomy or laminectomy (Group B). They compared the degree of cervical lordosis after laminoplasty with preoperative measurements. Neurological function at last follow-up was also compared with preoperative assessments.

Results: In Group A, the mean values for pre- and postoperative cervical lordosis were 14.5 and 10.9 degrees, respectively (p > 0.18). In female patients, however, the pre- and postoperative means were 14.4 and 3.7 degrees, respectively (p < 0.004). In Group B, the overall means for pre- and postoperative cervical lordosis were 17.3 and 19.1 degrees, respectively (p > 0.48); the corresponding means for female patients were 15.0 and 14.1 degrees (p > 0.83). The mean percentages of neurological recovery were 54.1% in Group A and 54.8% in Group B.

Conclusions: Preservation of the insertion of the deep extensor musculature to the C-2 spinous process prevented significant changes in cervical alignment after laminoplasty, even among female patients. Neurological recovery was not affected by the loss of cervical lordosis.