C2 Laminoplasty with Reconstruction of the Deep Extensor Muscles for Preventing Cervical Kyphosis after High Cervical...

Cervical kyphosis after an intradural spinal tumor is a significant complication, especially for high cervical tumors that require a C2 laminectomy. This study presents our new surgical approach: a C2 laminoplasty with reconstruction of the cervical deep extensor muscles. We investigated whether the C2 reconstruction technique contributes to maintaining cervical alignment.Consecutive adult patients (≥18 years) who underwent the C2 reconstruction technique for intradural high cervical tumors between 2015 and 2024 were included. The preoperative and postoperative C2/7 angles were compared.A total of 21 patients (median age 50 years, interquartile range 44-75 years; 10 men) were included. Histological diagnoses included 11 intramedullary and 10 intradural extramedullary tumors, with schwannoma (29%) and ependymoma (24%) being the 2 most frequent tumors. The tumor center was located between C1 and C3 in 90% of patients, and the median tumor size was 29 mm. The C2 spinous processes were split in the midline from the C2 lamina without detaching the attached muscles. At the end of surgery, the C2 lamina was fixed, and the bilateral C2 spinous processes were sutured back to the C2 lamina along with their attached muscles. The pre- and postoperative C2/7 angles did not significantly differ (11.5 vs 10.6°, p = 0.65). No patients had cervical kyphosis that required instrumented fusion at the median follow-up of 37 months (interquartile range 14-63 months).For patients with cervical spinal tumors, the reconstruction of the C2 deep extensor muscles may contribute to maintaining cervical alignment.