scholarly journals C5 palsy in the treatment of cervical spondylosis myelopathy with ossification of the posterior longitudinal ligament

2020 ◽  
Author(s):  
denglu yan ◽  
Zaiheng Zhang ◽  
Zhi Zhang
Keyword(s):  
Spinal Cord ◽  
Clinical Outcomes ◽  
Cervical Spondylosis ◽  
Posterior Longitudinal Ligament ◽  
Posterior Surgery ◽  
C5 Palsy ◽  
Dural Sac ◽  
Csf Leakage ◽  
The Mean ◽  
Cervical Spondylosis Myelopathy

Abstract Background There are many factors that affect the C5 palsy in the treatment of cervical spondylosis myelopathy (CSM) with ossification of the posterior longitudinal ligament (OPLL), but the spinal compression degrees may be an important factor in affection on it. Objective The purpose of this study was to evaluate the effect of spinal cord compression degrees on the clinical outcomes of OPLL patients which been treated by anterior and posterior surgery. Methods From May 2010 to October 2017, 145 patients cervical spondylosis myelopathy with OPLL (spinal canal narrowing by the OPLL exceeded 30%) were enrolled in this study; 76 patients received anterior cervical corpectomy and fusion surgery (ACCF), and 69 patients had posterior cervical decompression and laminoplasty procedures (PCDL). The clinical outcomes of pain relief (visual analog scale, VAS), functional disability (neck disability index, NDI) were recorded at baseline and at the final follow-up. Results There were five patients with C5 palsy in this series cases (two in ACCF and three in PCDL), and the rate is 4.1% (3.2% in ACCF and 5.2% in PCDL, P > 0.05). Five C5 palsy cases had more than 50% compressed degrees of dural sac and flattened spinal cord, and the compressed dural sac and flattened spinal cord had totally expansion after operation. There were no patients resented with CSF leakage in PCDL group, and six patients presented with CSF leakage in ACCF. The mean postoperative canal diameter were significant better than preoperative in PDL patients (P < 0.01). The average spinal sagittal and axial compressive ratio were significantly decreased from preoperative in ACR and PDL groups (P < 0.01). The mean cervical ROM values were decreased in ACR and PDL groups (P< 0.05). Conclusions Based on the results of this study, anterior and posterior surgery was effective and safe in the treatment of the OPLL patients. The complication of C5 palsy were no related in the surgery methods, but may be related the degrees of spinal cord compressed.

Microsurgical resection of ossification of the posterior longitudinal ligament in the thoracic spine via the transthoracic approach without spinal fusion: case series and technical note

2019 ◽  
Vol 31 (3) ◽  
pp. 326-333
Author(s):  
Ryo Kanematsu ◽  
Junya Hanakita ◽  
Toshiyuki Takahashi ◽  
Yosuke Tomita ◽  
Manabu Minami
Keyword(s):  
Spinal Cord ◽  
Spinal Fusion ◽  
Thoracic Spine ◽  
Posterior Longitudinal Ligament ◽  
Anterolateral Approach ◽  
Thoracic Myelopathy ◽  
Kyphotic Angle ◽  
Thoracic Spinal Cord ◽  
Csf Leakage ◽  
The Mean

OBJECTIVESurgical management of thoracic ossification of the posterior longitudinal ligament (OPLL) remains challenging because of the anatomical complexity of the thoracic spine and the fragility of the thoracic spinal cord. Several surgical approaches have been described, but it remains unclear which of these is the most effective. The present study describes the microsurgical removal of OPLL in the middle thoracic level via the transthoracic anterolateral approach without spinal fusion, including the surgical outcome and operative tips.METHODSBetween 2002 and 2017, a total of 8 patients with thoracic myelopathy due to OPLL were surgically treated via the transthoracic anterolateral approach without spinal fusion. The surgical techniques are described in detail. Clinical outcome, surgical complications, and the pre- and postoperative thoracic kyphotic angle were assessed.RESULTSThe mean patient age at the time of surgery was 55 years (range 47–77 years). There were 5 women and 3 men. The surgically treated levels were within T3–9. The clinical symptoms and Japanese Orthopaedic Association (JOA) score improved postoperatively in 7 cases, but did not change in 1 case. The mean JOA score increased from 6.4 preoperatively to 7.5 postoperatively (recovery rate 26%). Intraoperative CSF leakage occurred in 4 cases, and was successfully treated with fibrin glue sealing and spinal drainage. The mean follow-up period was 82.6 months (range 15.3–169 months). None of the patients had deterioration of the thoracic kyphotic angle.CONCLUSIONSAnterior decompression is the logical and ideal procedure to treat thoracic myelopathy caused by OPLL on the concave side of the spinal cord; however, this procedure is technically demanding. Microsurgery via the transthoracic anterolateral approach enables direct visualization of the thoracic ventral ossified lesion. The use of microscopic procedures might negate the need for bone grafting or spinal instrumentation.

Is there a difference in range of motion, neck pain, and outcomes in patients with ossification of posterior longitudinal ligament versus those with cervical spondylosis, treated with plated laminoplasty?

2013 ◽  
Vol 35 (1) ◽  
pp. E9 ◽  
Author(s):  
Takahito Fujimori ◽  
Hai Le ◽  
John E. Ziewacz ◽  
Dean Chou ◽  
Praveen V. Mummaneni
Keyword(s):  
Neck Pain ◽  
Range Of Motion ◽  
Clinical Outcomes ◽  
San Francisco ◽  
Japanese Orthopaedic Association ◽  
Minimum Clinically Important Difference ◽  
Posterior Longitudinal Ligament ◽  
Flexion Angle ◽  
Radiographic Outcomes ◽  
The Mean

Object There are little data on the effects of plated, or plate-only, open-door laminoplasty on cervical range of motion (ROM), neck pain, and clinical outcomes. The purpose of this study was to compare ROM after a plated laminoplasty in patients with ossification of posterior longitudinal ligament (OPLL) versus those with cervical spondylotic myelopathy (CSM) and to correlate ROM with postoperative neck pain and neurological outcomes. Methods The authors retrospectively compared patients with a diagnosis of cervical stenosis due to either OPLL or CSM who had been treated with plated laminoplasty in the period from 2007 to 2012 at the University of California, San Francisco. Clinical outcomes were measured using the modified Japanese Orthopaedic Association (mJOA) scale and neck visual analog scale (VAS). Radiographic outcomes included assessment of changes in the C2–7 Cobb angle at flexion and extension, ROM at C2–7, and ROM of proximal and distal segments adjacent to the plated lamina. Results Sixty patients (40 men and 20 women) with an average age of 63.1 ± 10.9 years were included in the study. Forty-one patients had degenerative CSM and 19 patients had OPLL. The mean follow-up period was 20.9 ± 13.1 months. The mean mJOA score significantly improved in both the CSM and the OPLL groups (12.8 to 14.5, p < 0.01; and 13.2 to 14.2, respectively; p = 0.04). In the CSM group, the mean VAS neck score significantly improved from 4.2 to 2.6 after surgery (p = 0.01), but this improvement did not reach the minimum clinically important difference (MCID). Neither was there significant improvement in the VAS neck score in the OPLL group (3.6 to 3.1, p = 0.17). In the CSM group, ROM at C2–7 significantly decreased from 32.7° before surgery to 24.4° after surgery (p < 0.01). In the OPLL group, ROM at C2–7 significantly decreased from 34.4° to 20.8° (p < 0.01). In the CSM group, the change in the VAS neck score significantly correlated with the change in the flexion angle (r = − 0.31) and the extension angle (r = − 0.37); however, it did not correlate with the change in ROM at C2–7 (r = − 0.1). In the OPLL group, the change in the VAS neck score did not correlate with the change in the flexion angle (r = 0.03), the extension angle (r = − 0.17), or the ROM at C2–7 (r = − 0.28). The OPLL group had a significantly greater loss of ROM after surgery than did the CSM group (p = 0.04). There was no significant correlation between the change in ROM and the mJOA score in either group. Conclusions Plated laminoplasty in patients with either OPLL or CSM decreases cervical ROM, especially in the extension angle. Among patients who have undergone laminoplasty, those with OPLL lose more ROM than do those with CSM. No correlation was observed between neck pain and ROM in either group. Neither group had a change in neck pain that reached the MCID following laminoplasty. Both groups improved in neurological function and outcomes.

scholarly journals Efficacy of posterior decompression and fixation based on ossification-kyphosis angle criteria for multilevel ossification of the posterior longitudinal ligament in the thoracic spine

2018 ◽  
Vol 29 (2) ◽  
pp. 150-156 ◽  
Author(s):  
Hiroshi Uei ◽  
Yasuaki Tokuhashi ◽  
Masashi Oshima ◽  
Masafumi Maseda ◽  
Masahiro Nakahashi ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Vertebral Body ◽  
Thoracic Spine ◽  
Free Space ◽  
Posterior Longitudinal Ligament ◽  
Kyphosis Angle ◽  
Posterior Decompression ◽  
Significant Difference ◽  
The Mean ◽  
Spinal Cord Decompression

OBJECTIVEThe range of decompression in posterior decompression and fixation for ossification of the posterior longitudinal ligament in the thoracic spine (T-OPLL) can be established using an index of spinal cord decompression based on the ossification-kyphosis angle (OKA) measured in the sagittal view on MRI. However, an appropriate OKA cannot be achieved in some cases, and posterior fixation is applied in cases with insufficient decompression. Moreover, it is unclear whether spinal cord decompression of the ventral side is essential for the treatment of OPLL. In this retrospective analysis, the efficacy of posterior decompression and fixation performed for T-OPLL was investigated after the range of posterior decompression had been set using the OKA.METHODSThe MRI-based OKA is the angle from the superior margin at the cranial vertebral body of the decompression site and from the lower posterior margin at the caudal vertebral body of the decompression site to the prominence of the maximum OPLL. Posterior decompression and fixation were performed in 20 patients. The decompression range was set so that the OKA was ≤ 23° or the minimum if this value could not be achieved. Cases in which an OKA ≤ 23° could and could not be achieved were designated as groups U (13 patients) and O (7 patients), respectively. The mean patient ages were 50.5 and 62.1 years (p = 0.03) and the mean preoperative Japanese Orthopaedic Association (JOA) scores were 5.9 and 6.0 (p = 0.9) in groups U and O, respectively. The postoperative JOA score, rate of improvement of the JOA score, number of levels fused, number of decompression levels, presence of an echo-free space during surgery, operative time, intraoperative blood loss, and perioperative complications were examined.RESULTSIn groups U and O, the mean rates of improvement in the JOA score were 50.0% and 45.6% (p = 0.3), the numbers of levels fused were 6.7 and 6.4 (p = 0.8), the numbers of decompression levels were 5.9 and 7.4 (p = 0.3), an echo-free space was noted during surgery in 92.3% and 42.9% of cases (p = 0.03), the operative times were 292 and 238 minutes (p = 0.3), and the intraoperative blood losses were 422 and 649 ml (p = 0.7), and transient aggravation of paralysis occurred as a perioperative complication in 2 and 1 patient, respectively.CONCLUSIONSThere was no significant difference with regard to the recovery rate of the JOA score between patients with (group U) and without (group O) sufficient spinal cord decompression. The first-line surgical procedure of posterior decompression and fixation with the range of posterior decompression set as an OKA ≤ 23° before surgery involves less risk of postoperative aggravation of paralysis and may result in a better outcome.

Transthoracic microsurgical anterior decompression without fusion for ossification of the posterior longitudinal ligament in the thoracic spine

2020 ◽  
Vol 33 (6) ◽  
pp. 757-765
Author(s):  
Seokjin Ko ◽  
Junseok Bae ◽  
Sang-Ho Lee
Keyword(s):  
Risk Factors ◽  
Recovery Rate ◽  
Japanese Orthopaedic Association ◽  
Postoperative Outcome ◽  
Posterior Longitudinal Ligament ◽  
Anterior Decompression ◽  
Kyphotic Angle ◽  
Csf Leakage ◽  
Independent Risk Factors ◽  
The Mean

OBJECTIVEThe authors aimed to analyze outcomes following transthoracic microsurgical anterior decompression of thoracic ossification of the posterior longitudinal ligament (T-OPLL), which was causing myelopathy, and determine the predictive factors for surgical outcomes.METHODSPatients who underwent transthoracic microsurgical anterior decompression without fusion for the treatment of T-OPLL from December 2014 to May 2019 were included. Demographic, radiological, and perioperative data and clinical outcomes of 35 patients were analyzed. The modified Japanese Orthopaedic Association (mJOA) score and recovery rate were used to evaluate functional outcomes.RESULTSA total of 35 consecutive patients (8 men and 27 women; mean age 52.2 ± 10.8 years) were enrolled in this study, and the mean follow-up period was 65.5 ± 51.9 months. The mean mJOA score significantly improved after surgery (5.9 ± 1.8 vs 8.3 ± 1.5, p < 0.001), with a mean recovery rate of 47.7% ± 24.5%. The visual analog scale (VAS) score significantly improved after surgery (7.3 ± 1.3 vs 4.3 ± 0.7, p < 0.001). The outcome was excellent in 4 patients (11.4%), good in 21 patients (60.0%), fair in 4 patients (11.4%), unchanged in 5 patients (14.3%), and worsened in 1 patient (2.9%). There were 12 cases of CSF leakage, 1 case of epidural hematoma, 1 case of pleural effusion, and 1 case of pneumothorax. Age, preoperative kyphotic angle, anteroposterior length of T-OPLL at the maximally affected level, and mass occupying rate were identified as predictors associated with postoperative outcome. A multivariate regression analysis revealed that age and preoperative kyphotic angle were independent risk factors for postoperative outcomes.CONCLUSIONSTransthoracic microsurgical anterior decompression without fusion achieved favorable clinical and radiological outcomes for treating T-OPLL with myelopathy. Patient age and preoperative kyphotic angle were independent risk factors for lower recovery rate.

scholarly journals Surgical results and complications of anterior decompression and fusion as a revision surgery after initial posterior surgery for cervical myelopathy due to ossification of the posterior longitudinal ligament

2017 ◽  
Vol 26 (4) ◽  
pp. 466-473 ◽  
Author(s):  
Seiichi Odate ◽  
Jitsuhiko Shikata ◽  
Tsunemitsu Soeda ◽  
Satoru Yamamura ◽  
Shinji Kawaguchi
Keyword(s):  
Revision Surgery ◽  
Cervical Myelopathy ◽  
Posterior Longitudinal Ligament ◽  
Neurological Deterioration ◽  
Surgical Results ◽  
Improvement Rate ◽  
Posterior Surgery ◽  
Initial Surgery ◽  
The Mean

OBJECTIVE Ossification of the posterior longitudinal ligament (OPLL) is a progressive disease. An anterior cervical decompression and fusion (ACDF) procedure for cervical OPLL is theoretically feasible, as the lesion exists anteriorly; however, such a procedure is considered technically demanding and is associated with serious complications. Cervical laminoplasty is reportedly an effective alternative procedure with few complications; it is recognized as a comparatively safe procedure, and has been widely used as an initial surgery for cervical OPLL. After posterior surgery, some patients require revision surgery because of late neurological deterioration due to kyphotic changes in cervical alignment or OPLL progression. Here, the authors retrospectively investigated the surgical results and complications of revision ACDF after initial posterior surgery for OPLL. METHODS This was a single-center, retrospective study. Between 2006 and 2013, 19 consecutive patients with cervical OPLL who underwent revision ACDF at the authors' institution after initial posterior surgery were evaluated. The mean age at the time of revision ACDF was 66 ± 7 years (± SD; range 53–78 years). The mean interval between initial posterior surgery and revision ACDF was 63 ± 53 months (range 3–235 months). RESULTS The mean follow-up period after revision ACDF was 41 ± 26 months (range 24–108 months). Before revision ACDF, the mean maximum thickness of the ossified posterior longitudinal ligament was 7.2 ± 1.5 mm (range 5–10 mm), and the mean C2–7 angle was 1.3° ± 14° (range −40° to 24°). The K-line was plus (OPLL did not exceed the K-line) in 8 patients and minus in 11 (OPLL exceeded the K-line). The mean Japanese Orthopaedic Association score improved from 10 ± 3 (range 3–15) before revision ACDF to 11 ± 4 (range 4–15) at the last follow-up, and the mean improvement rate was 18% ± 18% (range 0%–60%). A total of 16 surgery-related complications developed in 12 patients (63%). The main complication was an intraoperative CSF leak in 8 patients (42%). Neurological function worsened in 5 patients (26%). The deterioration was due to spinal cord herniation through a defective dura mater in 1 patient, unidentified in 1 patient, and C-5 palsy that gradually recovered in 3 patients. Reintubation, delirium, and hoarseness were observed in 1 patient each (5%). No patient required reoperation for reconstruction failure, and all patients eventually had a solid bony fusion. CONCLUSIONS ACDF as revision surgery after initial posterior surgery for cervical myelopathy due to OPLL is associated with a high incidence of intraoperative CSF leakage and an extremely low improvement rate. The authors think that while the use of revision ACDF must be limited, it is indispensable in special cases, such as progressing myelopathy following posterior surgery due to a very large beak-type OPLL that exceeds the K-line. Postoperative OPLL progression and/or kyphotic changes can possibly cause later neurological deterioration. Fusion should be recommended at the initial surgery for many cases of cervical OPLL to prevent such a challenging revision surgery.

scholarly journals Epidemiology of Spinal Cord Injury: Changes to Its Cause Amid Aging Population, a Single Center Study

2021 ◽  
Vol 45 (1) ◽  
pp. 7-15
Author(s):  
Ha Seong Kim ◽  
Kil-Byung Lim ◽  
Jiyong Kim ◽  
Joongmo Kang ◽  
Hojin Lee ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Motor Vehicle ◽  
Posterior Longitudinal Ligament ◽  
The Elderly ◽  
Motor Vehicle Crash ◽  
Cross Sectional ◽  
Common Cause ◽  
Cord Injury ◽  
The Mean

Objective To investigate the epidemiologic and demographic characteristics of patients with spinal cord injury (SCI) who were admitted to a department of rehabilitation of a university hospital.Methods This was a descriptive cross-sectional study. Medical records including sex, age at injury, type of disability, traumatic or non-traumatic etiology and presence of ossification of posterior longitudinal ligament (OPLL) of patients with SCI who were admitted to the department of rehabilitation between 2012 and 2018 were reviewed.Results Of the 221 cases of SCI, 161 were traumatic and 60 were non-traumatic. The mean age at injury was 52.8 years. People aged 40–49 years showed highest proportion among overall SCI patients (19.0%). The proportion of male patients was higher in traumatic SCI at 4.96:1 than in non-traumatic SCI at 1.30:1. The most common cause of traumatic SCI was falling off (37.3%), followed by motor vehicle crash (35.4%) and tripping over (19.3%). Meanwhile, the most common cause of non-traumatic SCI was neoplasm (35.0%). Tripping over was the leading cause of traumatic SCI in patients aged ≥60 years (42.6%). A high proportion of traumatic SCI patients were found to have underlying OPLL (26.1%), particularly those who were injured by tripping over (64.5%).Conclusion The mean age of SCI patients was higher than that of previous studies. Falls was the single most common cause of traumatic SCI, and tripping over was the most common cause of injury in the elderly patients. OPLL was prevalent in patients who were injured from tripping over.

scholarly journals Surgery-related predictable risk factors influencing postoperative clinical outcomes for thoracic myelopathy caused by ossification of the posterior longitudinal ligament: a multicenter retrospective study

2020 ◽  
Vol 32 (5) ◽  
pp. 703-709
Author(s):  
Hirokazu Saiwai ◽  
Seiji Okada ◽  
Mitsumasa Hayashida ◽  
Katsumi Harimaya ◽  
Yoshihiro Matsumoto ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Outcomes ◽  
Surgical Outcomes ◽  
Japanese Orthopaedic Association ◽  
Posterior Longitudinal Ligament ◽  
Neurological Status ◽  
Thoracic Myelopathy ◽  
Number Of Patients ◽  
Surgical Methods ◽  
Csf Leakage

OBJECTIVECompression of the spinal cord by thoracic ossification of the posterior longitudinal ligament (T-OPLL) often causes severe thoracic myelopathy. Although surgery is the most effective treatment for T-OPLL, problems associated with surgical intervention require resolution because surgical outcomes are not always favorable, and a small number of patients experience deterioration of their neurological status after surgery. The aim of the present study was to examine the surgery-related risk factors contributing to poor clinical outcomes for myelopathy caused by T-OPLL.METHODSData were extracted from the records of 55 patients with thoracic myelopathy due to T-OPLL at institutions in the Fukuoka Spine Group. The mean follow-up period was 5.3 years. Surgical outcomes were assessed using the Japanese Orthopaedic Association (JOA) scale. To investigate the definitive factors associated with surgical outcomes, univariate and multivariate regression analyses were performed with several patient-related and surgery-related factors, including preoperative comorbidities, radiological findings, JOA score, surgical methods, surgical outcomes, and complications.RESULTSNeurological status improved in 33 patients (60.0%) and deteriorated in 10 patients (18.2%) after surgery. The use of instrumentation was significantly associated with an improved outcome. In the comparison of surgical approaches, posterior decompression and fusion resulted in a significantly higher neurological recovery rate than did anterior decompression via a posterior approach and fusion or decompression alone. It was also found that postoperative neurological status was significantly poorer when there were fewer instrumented spinal levels than decompression levels. CSF leakage was a predictable risk factor for deterioration following surgery.CONCLUSIONSIt is important to identify preventable risk factors for poor surgical outcomes for T-OPLL. The findings of the present study suggest that intraoperative CSF leakage and a lower number of instrumented spinal fusion levels than decompression levels were exacerbating factors for the neurological improvement in T-OPLL surgery.

scholarly journals The impact of dynamic factors on surgical outcomes after double-door laminoplasty for ossification of the posterior longitudinal ligament of the cervical spine

2014 ◽  
Vol 21 (6) ◽  
pp. 938-943 ◽  
Author(s):  
Keishi Maruo ◽  
Tokuhide Moriyama ◽  
Toshiya Tachibana ◽  
Shinichi Inoue ◽  
Fumihiro Arizumi ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Cervical Myelopathy ◽  
Recovery Rate ◽  
Posterior Longitudinal Ligament ◽  
Dynamic Factors ◽  
The Mean ◽  
The Impact

Object Laminoplasty is the preferred operation for most patients with cervical myelopathy due to multilevel ossification of the posterior longitudinal ligament (OPLL). Recent studies have demonstrated several significant risk factors for poor clinical outcomes after laminoplasty, including older age, lower preoperative Japanese Orthopaedic Association (JOA) score, postoperative change in cervical alignment, cervical kyphosis, and high occupying ratio of the OPLL (that is, the ratio of the greatest anteroposterior thickness of the OPLL to the anteroposterior diameter of the spinal canal at the same level on a lateral image). However, the impact of dynamic factors on clinical outcomes is unclear. The purpose of this study is to assess the impact of dynamic factors on the clinical outcome after laminoplasty for cervical myelopathy due to OPLL. Methods A consecutive series of patients who underwent laminoplasty for cervical myelopathy due to OPLL between 2003 and 2009 was retrospectively reviewed. The indication for laminoplasty at the authors' hospital included preoperative straight or lordotic alignment of the cervical spine and an occupying ratio of OPLL less than 60%. The JOA score and recovery rate were used to evaluate clinical outcomes. A poor clinical outcome was defined as a recovery rate of less than 50%. Patient factors examined along with outcome included age, preoperative JOA score, preoperative somatosensory evoked potentials, preoperative motor evoked potentials, body mass index, and presence of high intensity on MRI. Radiographic measures included the preoperative C2–7 lordotic angle, preoperative C2–7 range of motion (ROM), preoperative segmental ROM at the level of myelopathy, and the occupying ratio of OPLL. Results There were 45 patients (33 males and 12 females). The mean follow-up period was 4 years (range 2–6.8 years). The mean patient age was 66.9 years (range 50–85 years). The mean JOA score significantly increased from 9.1 before surgery to 13.1 at the final follow-up. The mean recovery rate was 51.2%. Nineteen patients (42%) had a recovery rate of less than 50%. Patient factors were not associated with surgical outcomes. Only the preoperative C2–7 ROM was significantly greater in the poor surgical outcome group (23.1° vs 14.1°). Receiver operating characteristic curve analysis showed that the optimal preoperative C2–7 ROM cutoff was 20°. Logistic regression analysis revealed that patients with a preoperative C2–7 ROM of greater than 20° had a 4.6 times higher risk (p = 0.021) of a poor clinical outcome, indicating that dynamic factors may have an impact on the surgical outcome of laminoplasty. Conclusions Fusion surgery may be a useful strategy in patients with preoperative hypermobility of the cervical spine.

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