Is Preoperative Spondylolisthesis A Contraindication To Laminoplasty

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To evaluate radiographic changes in cervical spondylolisthesis following posterior cervical laminoplasty. SUMMARY OF BACKGROUND DATA: Posterior cervical laminoplasty is an effective motion-preserving surgery for multilevel cervical stenosis and myelopathy. A frequently cited contraindication is spondylolisthesis, due to concern that laminoplasty may worsen instability or accelerate progression of the slip. However, there is limited evidence evaluating outcomes in this patient population, particularly in United States. METHODS: All patients undergoing posterior cervical laminoplasty from 2015 to 2023 at a single tertiary academic center were reviewed. Preoperative radiographs were screened, and patients with >2 mm of cervical spondylolisthesis were identified. Demographic variables including age and BMI were recorded. Radiographic measures included spondylolisthesis length (mm), slip percentage, and cervical alignment parameters (C2-7 lordosis, sagittal vertical axis, segmental lordosis). Neutral lateral radiographs were analyzed at baseline, <1 month, 3 months, 6 months, 1 year, and final follow-up. RESULTS: Of 515 patients reviewed, 80 had preoperative spondylolisthesis. The mean preoperative listhesis was 3.4±1.1 mm, most commonly at C3-4 (n=28). The mean radiographic follow-up was 16 months. Neither spondylolisthesis length nor slip percentage changed significantly over time (P=0.3096 and 0.2673, respectively). Greater C2-7 lordosis and segmental lordosis at the spondylolisthesis level were associated with a statistically greater degree of listhesis (P=0.0422), though the absolute effect size was minimal (0.0129 mm increase per 1 degree increase in lordosis). CONCLUSIONS: This study represents the largest US cohort of patients with cervical spondylolisthesis undergoing laminoplasty. Findings suggest that mild preoperative spondylolisthesis does not progress after laminoplasty, supporting the procedure as a safe motion-preserving option in appropriately selected patients. Alignment parameters, such as global and segmental lordosis, may influence listhesis, but their clinical significance appears minimal. Further multicenter studies with longer follow-up are warranted.