Comparison of Range of Motion Outcomes in Patients Undergoing Open-Door Laminoplasty or Posterior Cervical Fusion Surgery for Cervical Spondylotic Myelopathy

Abstract

Aim: This study aimed to compare neurological and functional outcomes, including cervical range of motion (ROM), in patients with cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament (OPLL) who underwent either open-door laminoplasty (LP) or posterior cervical fusion (PCF) surgery. Material and Methods: This retrospective, single-center study included 38 patients, 11 female and 27 male, diagnosed with CSM and OPLL who underwent LP (n=20) or PCF (n=18) between 2014 and 2016. Clinical outcomes were assessed using the Japanese Orthopedic Association (JOA), visual analog scale (VAS), and Nurick scores. Cervical ROM values, including flexion, extension, lateral flexion, and rotation, were measured preoperatively and six months postoperatively in collaboration with physical therapy specialists. Results: Both LP and PCF groups showed significant postoperative improvement in JOA, VAS, and Nurick scores (all p<0.001), with no significant differences between groups (p=0.405, p=0.708, and p=0.963, respectively). Cervical ROM values significantly decreased in all directions postoperatively in both groups. Flexion (p<0.001), left lateral flexion (p=0.007), and left rotation (p=0.003) declined more severely in the PCF group, whereas the difference between groups did not reach statistical significance level in extension (p=0.105), right lateral flexion (p=0.065), and right rotation (p=0.067). Conclusion: LP and PCF offer similar neurological recovery in patients with CSM. However, LP better preserves postoperative cervical ROM. Despite the observed ROM reduction, daily functional activities remained largely unaffected. Long-term, larger studies are recommended for further validate these findings.

Keywords

• Cervical spondylotic myelopathy
• lateral mass
• laminoplasty
• range of motion

Servikal Spondilotik Miyelopati Nedeniyle Open-Door Laminoplasti veya Posterior Servikal Füzyon Cerrahisi Geçiren Hastalarda Hareket Açıklığı Sonuçlarının Karşılaştırılması

Abstract

Amaç: Bu çalışmanın amacı, servikal spondilotik miyelopati (CSM) ve arka longitudinal ligamentin osifikasyonu (OPLL) nedeniyle open-door laminoplasti (LP) veya posterior servikal füzyon (PCF) ameliyatı geçiren hastalarda, servikal hareket açıklığı (ROM) dahil olmak üzere nörolojik ve fonksiyonel sonuçları karşılaştırmaktır. Gereç ve Yöntemler: Bu geriye dönük tek merkezli çalışmaya, 2014 ve 2016 yılları arasında CSM ve OPLL tanısıyla LP (n=20) veya PCF (n=18) ameliyatı geçiren, 11 kadın ve 27 erkek olmak üzere toplam 38 hasta dahil edildi. Klinik sonuçlar, Japon Ortopedi Derneği (JOA), görsel analog skala (VAS) ve Nurick skorları kullanılarak değerlendirildi. Fleksiyon, ekstansiyon, lateral fleksiyon ve rotasyon değerlerini içeren servikal ROM değerleri ameliyat öncesi ve ameliyat sonrası altıncı ayda fizik tedavi uzmanlarının iş birliğiyle ölçüldü. Bulgular: Hem LP hem de PCF gruplarında JOA, VAS ve Nurick skorlarında ameliyat sonrası anlamlı iyileşme gözlendi (tüm p<0,001), gruplar arasında anlamlı fark yoktu (sırasıyla p=0,405, p=0,708 ve p=0,963). Ameliyat sonrası her iki grupta da servikal ROM değerleri tüm yönlerde anlamlı şekilde azaldı. Fleksiyon (p<0,001), sol lateral fleksiyon (p=0,007) ve sol rotasyon (p=0,003) PCF grubunda daha belirgin şekilde azalırken, ekstansiyon (p=0,105), sağ lateral fleksiyon (p=0,065) ve sağ rotasyon (p=0,067) için gruplar arasındaki farklar istatistiksel anlamlılık düzeyine ulaşmadı. Sonuç: LP ve PCF, CSM hastalarında benzer nörolojik iyileşme sağlamaktadır. Ancak LP, ameliyat sonrası servikal ROM'u daha iyi korumaktadır. Her ne kadar ROM'da azalma gözlense de, günlük fonksiyonel aktiviteler büyük ölçüde etkilenmemiştir. Bulguların doğrulanması için uzun dönemli daha geniş çalışmalara ihtiyaç vardır.

Keywords

• Servikal spondilotik miyelopati
• lateral mas
• laminoplasti
• hareket açıklığı

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