Preoperative cervical extension range of motion and C7 preservation as predictors of axial symptoms following laminoplasty.

PURPOSE: To identify independent predictors of postoperative axial symptoms (AS) after cervical laminoplasty (CLP) and evaluate the predictive value of preoperative cervical range of motion. METHODS: We retrospectively reviewed 191 patients with cervical spondylotic myelopathy who underwent unilateral open-door CLP between January 2019 and January 2024. Patients were classified into AS (n=73) and no AS (n=118) groups. Demographic, surgical, radiographic, and clinical variables were compared. Binary logistic regression identified independent predictors, and receiver operating characteristic analysis assessed predictive performance. RESULTS: Compared with the no-AS group, the AS group had higher BMI (26.5±3.7 vs. 25.4±3.3 kg/m2, P=0.027), more frequent T2-weighted spinal cord increased signal intensity (64.4% vs. 44.9%, P=0.009), higher prevalence of radiographic ossification of the posterior longitudinal ligament (OPLL) (38.4% vs. 19.5%, P=0.004), higher preoperative neck VAS scores (2.2±1.8 vs. 1.1±1.7, P<0.001), higher flexion ROM (30.5±9.6° vs. 27.1±8.9°, P=0.004), and lower extension ROM (7.2±4.2° vs. 12.7±6.5°, P<0.001). Logistic regression identified BMI (OR=1.166), neck VAS (OR=1.356), extension ROM (OR=0.717), flexion ROM (OR=1.117), and C7 preservation (OR=0.323) as independent predictors. Extension ROM showed the highest predictive value (AUC=0.758), with an optimal cutoff of 9.650°. CONCLUSION: Reduced preoperative extension ROM and non-preservation of C7 independently predicted AS after CLP. These parameters may improve AS risk stratification.