Factors Associated with Poorer Outcomes After Laminoplasty
Patients with lower preoperative Japanese Orthopaedic Association (JOA) scores (<9-12), longer symptom duration (>12 months), and radiographic findings such as transverse cord area <40 mm² and multisegmental T2 hyperintensity have significantly poorer outcomes after cervical laminoplasty. 1
Preoperative Clinical Factors
- Lower preoperative JOA scores (<9-12) strongly correlate with worse outcomes after laminoplasty 1
- Longer symptom duration (>12 months) is associated with poorer outcomes, particularly in younger patients (<70 years) 1, 2
- Increased severity of myelopathy before surgery negatively impacts recovery potential 2
- Presence of chronic kidney disease (CKD) significantly reduces JOA score recovery rates (36.1% in patients with CKD vs. 44.7% in those without) 3
Radiographic Predictors
- Transverse cord area <40 mm² is associated with poor functional recovery 1
- Multisegmental hyperintensity on T2-weighted MRI strongly correlates with poor outcomes (p < 0.01) 1
- Poor anteroposterior canal ratio is linked to worse recovery 1
- Aortic arch calcification (AoAC), a marker of systemic atherosclerosis, is a significant independent predictor of poor outcomes (JOA recovery rate of 26.0% in patients with AoAC vs. 48.9% in those without) 3
- For patients with ossification of the posterior longitudinal ligament (OPLL), hill-shaped lesions may predict poorer outcomes 2
- K-line (-) in the neck-flexion position [f-K-line (-)] significantly correlates with poorer functional recovery, higher pain intensity, and lower patient satisfaction after laminoplasty for OPLL 4
Surgical Technique-Related Factors
- Elevation of laminae to an angle >60° significantly increases the risk of C5 palsy 1, 5
- Development of postoperative kyphosis, including postlaminoplasty kyphosis and local kyphosis, predicts poor outcomes 1, 6
- Boomerang deformity (spinal cord migration between split laminae) negatively impacts outcomes 1
- Higher preoperative cervical range of motion (ROM) is associated with poor clinical outcomes (OR 0.860,95% CI 0.788-0.940, p=0.001) 7
Postoperative Complications Affecting Outcomes
- C5 nerve root dysfunction develops in approximately 8% of patients, typically around 4-5 days after surgery 1, 6
- Post-surgical kyphosis occurs in approximately 10% of patients 5
- Postoperative axial neck pain has been reported in 6-60% of patients 6
- Significant decrease in cervical ROM (mean decrease 50%, range 17-80%) occurs after laminoplasty 6
Common Pitfalls to Avoid
- Excessive laminae elevation (angles >60°) significantly increases C5 palsy risk 1, 5
- Inadequate radiographic assessment, including failure to evaluate spinal cord compression parameters and T2 signal changes, can lead to suboptimal surgical planning 1
- Delaying surgery in patients with progressive myelopathy may result in poorer outcomes, as increased severity and longer duration of symptoms correlate with worse recovery 1, 2
- Failure to consider systemic comorbidities like CKD and vascular disease (indicated by AoAC) when selecting surgical candidates 3
- Not accounting for preoperative cervical mobility when predicting outcomes, as higher preoperative ROM correlates with poorer results 7