Preoperative cervical extension range of motion and C7 preservation as predictors of axial symptoms following laminoplasty.

PURPOSE: To identify independent predictors of postoperative axial symptoms (AS) after cervical laminoplasty (CLP) and evaluate the predictive value of preoperative cervical range of motion.

METHODS

We retrospectively reviewed 191 patients with cervical spondylotic myelopathy who underwent unilateral open-door CLP between January 2019 and January 2024. Patients were classified into AS (n=73) and no AS (n=118) groups. Demographic, surgical, radiographic, and clinical variables were compared. Binary logistic regression identified independent predictors, and receiver operating characteristic analysis assessed predictive performance.

RESULTS

Compared with the no-AS group, the AS group had higher BMI (26.5±3.7 vs. 25.4±3.3 kg/m2, P=0.027), more frequent T2-weighted spinal cord increased signal intensity (64.4% vs. 44.9%, P=0.009), higher prevalence of radiographic ossification of the posterior longitudinal ligament (OPLL) (38.4% vs. 19.5%, P=0.004), higher preoperative neck VAS scores (2.2±1.8 vs. 1.1±1.7, P<0.001), higher flexion ROM (30.5±9.6° vs. 27.1±8.9°, P=0.004), and lower extension ROM (7.2±4.2° vs. 12.7±6.5°, P<0.001). Logistic regression identified BMI (OR=1.166), neck VAS (OR=1.356), extension ROM (OR=0.717), flexion ROM (OR=1.117), and C7 preservation (OR=0.323) as independent predictors. Extension ROM showed the highest predictive value (AUC=0.758), with an optimal cutoff of 9.650°.

CONCLUSION

Reduced preoperative extension ROM and non-preservation of C7 independently predicted AS after CLP. These parameters may improve AS risk stratification.