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February 11, 2026

Preoperative Cervical Extension and Flexion Range of Motion Predict Postoperative Kyphotic Change without Affecting 2-Year Clinical Outcomes Postoperatively after Laminoplasty for Degenerative Cervical Myelopathy

Key Points

To determine if preoperative cervical extension and flexion range of motion predict postoperative kyphotic change after laminoplasty.
Analyzed 147 patients over 60 with degenerative cervical myelopathy undergoing C3–C6 laminoplasty.
Measured radiographic parameters like cervical lordosis, extension range of motion, and flexion range of motion pre- and postoperatively.
Defined kyphotic change as cervical lordosis loss ≥10°.
Used logistic regression to identify predictors of kyphotic change.
Compared clinical outcomes, including JOA score and VAS for neck pain, between predictor-defined groups.
Kyphotic change occurred in 35 patients (23.8%) at 2 years postoperatively.
Small extension range of motion (≤9°) and large flexion range of motion (≥37°) predicted kyphotic change.
Higher incidence of kyphotic change in patients with small eROM and large fROM compared to counterparts.
No significant differences in clinical outcomes such as JOA score, VAS, EQ-5D-5L, or NDI postoperatively.

Abstract

Study Design. Multi-center retrospective cohort study Objective. To investigate whether preoperative cervical extension range of motion (eROM) and flexion range of motion (fROM) predict postoperative kyphotic change and affect clinical outcomes after laminoplasty for degenerative cervical myelopathy (DCM). Summary of Background Data. Cervical laminoplasty is a standard procedure for DCM; however, postoperative kyphotic change due to loss of cervical lordosis (CL) is a major concern. Although small eROM and large fROM may predict postoperative CL loss, their impact on clinical outcomes is unclear. Methods. We analyzed 147 patients with DCM ≥60 years who underwent C3–C6 laminoplasty with ≥2 years of follow-up. Radiographic parameters (CL, eROM, and fROM) were measured pre- and postoperatively. Kyphotic change was defined as CL loss ≥10°. Clinical outcomes included Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS) for neck pain, EuroQol 5-dimension 5-level instrument (EQ-5D-5L), and Neck Disability Index (NDI). Logistic regression was used to identify predictors of kyphotic change, and clinical outcomes were compared between predictor-defined groups up to 2 years postoperatively. Results. Kyphotic change occurred in 35 patients (23.8%) at 2 years postoperatively. Logistic regression revealed that small eROM (≤9°) and large fROM (≥37°) independently predicted postoperative kyphotic change at 1 and 2 years postoperatively. Its incidence in the small eROM and large fROM groups was significantly higher than that in their respective counterpart groups. No significant group differences were found in JOA score, VAS for neck pain, EQ-5D-5L, or NDI changes. Conclusion. Preoperative small eROM and large fROM independently predicted postoperative kyphotic change after laminoplasty for DCM. However, these factors did not negatively affect neurological recovery, neck pain, quality of life, or cervical function for up to 2 years postoperatively. Laminoplasty remains an effective option for patients with DCM with eROM ≤9° or fROM ≥37°, despite potential CL loss. Level of Evidence. III

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Preoperative Cervical Extension and Flexion Range of Motion Predict Postoperative Kyphotic Change without Affecting 2-Year Clinical Outcomes Postoperatively after Laminoplasty for Degenerative Cervical Myelopathy

Key Points

Abstract

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