Analysis of Risk Factors for Cervical Kyphotic Deformity Despite Laminar Reconstruction in Cervical Intradural Tumor...

Despite successful cervical intradural tumor resection, kyphotic deformity remains a significant concern affecting patients' quality of life. To prevent this, laminectomy is often followed by laminar reconstruction, yet kyphosis can still develop. The aim of this study was to identify risk factors contributing to postoperative kyphotic deformity in patients undergoing laminar reconstruction for cervical intradural tumors.

A retrospective review was conducted on patients who underwent surgery for cervical intradural tumors at a single institution from 2003 to 2023. Patients who had laminectomy at 2 or more levels with subsequent laminar reconstruction and a minimum follow-up of 1 year were included. C2-7 Cobb angle, C2-7 deep extensor muscle (DEM) area, flexion and extension reserve, and T1 slope were measured, along with clinical outcomes. Postoperative cervical kyphosis was defined as a C2-7 Cobb angle <0° at the last follow-up.

A total of 113 patients were analyzed. Postoperative cervical kyphosis developed in 32 (28.3%, mean follow-up 61.3 months). The kyphosis group showed an increased preoperative C2-7 Cobb angle (more kyphotic), greater C2-7 DEM area reduction, and lower preoperative and final T1 slopes than the nonkyphosis group. C2-7 DEM atrophy correlated with C2-7 Cobb angle change within the kyphosis group. No significant differences were found in tumor resection rates, complications, recurrence, or functional outcomes. Multivariate analysis identified preoperative cervical kyphosis (odds ratio [OR] 9.04, P = .001), C2 DEM detachment (OR 7.11, P = .001), and preoperative T1 slope (OR 0.91, P = .040) as independent risk factors.

Preoperative cervical kyphosis, C2 DEM detachment, and low preoperative T1 slope are significant risk factors of postoperative kyphosis despite laminar reconstruction. Close postoperative monitoring is crucial for these patients.