Impact of Preoperative Cervical Listhesis on Outcomes Following Unilateral Open-Door Cervical Laminoplasty.

Abstract

Retrospective cohort study. To evaluate the impact of preoperative cervical spondylolisthesis, defined as ≥2 mm of translation at any cervical level, on postoperative outcomes following unilateral open-door cervical laminoplasty. Cervical laminoplasty is a motion-preserving procedure for cervical spondylotic myelopathy (CSM). The effect of preoperative cervical listhesis on laminoplasty outcomes remains unclear, with mixed findings in the literature regarding its influence on pain relief, alignment, and complications. We retrospectively reviewed 104 patients who underwent unilateral open-door laminoplasty for CSM from 2017 to 2023 with at least 1 year of follow-up. Patients were grouped by presence (n = 43) or absence (n = 61) of preoperative listhesis. Demographics, radiographic parameters [eg, Torg-Pavlov ratio (TPR), C2 to C7 Cobb angle], and clinical outcomes (eg, VAS scores, complications) were compared. Multivariate logistic regression was used to assess whether listhesis predicted adverse outcomes. Both groups experienced significant postoperative VAS improvement, with no differences in pain relief, reoperation rates, hardware complications, or sagittal alignment. The listhesis group had a lower TPR (0.70 ± 0.112) than the no listhesis group (0.76 ± 0.115, P = 0.0043). Listhesis progression was minimal and not significant. At 1 year, there were no significant differences in reoperation (9.8% vs 2.3%, P = 0.132), screw backout (8.2% vs 0%, P = 0.054), or loss of lordosis ≥10 degrees (34.4% vs 39.5%, P = 0.594). Preoperative listhesis was not a predictor of adverse outcomes on multivariate analysis. Preoperative cervical listhesis was not associated with inferior outcomes following unilateral open-door laminoplasty. Both groups showed comparable improvements in pain and maintained spinal alignment, suggesting that mild to moderate listhesis may not be a significant determinant of surgical outcomes in this population. Level III.