Effects of Preservation of the Semispinalis Cervicis Inserted into C2 on Craniocervical Alignment After Laminoplasty

The preservation of nuchal musculature is essential for preventing axial pain and cervical malalignment after laminoplasty. A few studies have examined the effect of preservation of nuchal musculature on the degenerative progression after laminoplasty. We aimed to clarify the influence of preservation of the semispinalis cervicis inserted into C2 on cervical degenerative change and alignment after laminoplasty.

We retrospectively reviewed 106 consecutive patients who underwent C3-7 laminoplasty for cervical spondylotic myelopathy during 2006-2017. Patients were classified into 2 groups according to the preservation (P-group; n = 33) or detachment (D-group; n = 73) of the Semispinalis cervicis muscles inserted into the C2 spinous process. Parameters of cervical sagittal alignment, range of motion, and progressive degenerative changes next to or within the range of laminoplasty were evaluated in cervical spine radiographs, and magnetic resonance images obtained during follow-up period.

In the D-group, the postoperative C2-7 Cobb angle significantly decreased (-0.06°/month), while the O-C2 Cobb angle significantly increased (0.07°/month). In addition, the C2-7 range of motion significantly decreased in the D-group (-0.12°/month). Degenerative changes in the laminoplasty range were found in 5 patients per group. Three patients from the D-group developed retroodontoid pseudotumors (P < 0.001).

To maintain horizontal gaze, the craniocervical segment can compensate for the loss of lordosis by increasing the Cobb angle. Excessive compensation may exert mechanical stress on the atlantoaxial junction, contributing to the development of a retroodontoid pseudotumor. Preservation of the semispinalis cervicis inserted into C2 is critical for the prevention of malalignment after laminoplasty.