{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T08:28:36Z","timestamp":1766996916636,"version":"3.48.0"},"reference-count":19,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,12,28]],"date-time":"2025-12-28T00:00:00Z","timestamp":1766880000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: This study aimed to evaluate changes in cervical sagittal alignment after open-door laminoplasty and identify any specific preventable risk factors associated with postoperative kyphotic deformity. Materials and Methods: We retrospectively reviewed patients who underwent open-door laminoplasty for degenerative cervical stenosis between 2018 and 2021. Radiological assessment included pre- and postoperative C2\u2013C7 Cobb angles, cervical alignment categories (lordosis, straight, sigmoid, kyphosis), and K-line status. Early postoperative CT scans were analyzed for lamina fractures and facet joint disturbances. Clinical and demographic data, as well as surgical variables such as C3 involvement, were also recorded. Results: Among 78 patients with available pre- and postoperative MRI images (mean age 56.5 \u00b1 11.2 years; 42.3% female), the mean cervical lordosis decreased significantly from 8.78 \u00b1 13.75\u00b0 to 6.49 \u00b1 13.82\u00b0 (p = 0.024). Loss of lordosis was strongly associated with facet disturbance at the cranial-most operated level (p = 0.036), inclusion of C3 in laminoplasty (p = 0.031), and cranial-most lamina fractures (p = 0.004) in univariate analyses. However, in the multivariate logistic regression model, only the uppermost facet disturbance was identified as the independent risk factor for postoperative kyphotic change (OR 4.62, p = 0.039). C3 involvement and lamina fracture lost significance after adjustment, likely reflecting collinearity with facet injury at the cranial level. Other demographic or technical variables were not found to be statistically significant predictors. Conclusions: Postoperative sagittal alignment after laminoplasty is influenced by surgical complications at the cranial levels. A novel predictor\u2014uppermost facet disturbance\u2014emerged as a significant contributor to loss of lordosis. Preservation of these structures represents a practical strategy to reduce postoperative kyphotic drift. Prospective multicenter validation of the present study\u2019s findings is warranted.<\/jats:p>","DOI":"10.3390\/medicina62010058","type":"journal-article","created":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T07:52:59Z","timestamp":1766994779000},"page":"58","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["How Can We Prevent Postoperative Kyphosis in Cervical Laminoplasty?"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7933-821X","authenticated-orcid":false,"given":"Efecan","family":"Erisken","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Ataturk Training and Research Hospital, Izmir Katip Celebi University, 35620 Izmir, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3355-8954","authenticated-orcid":false,"given":"Selin","family":"Bozdag","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Ataturk Training and Research Hospital, Izmir Katip Celebi University, 35620 Izmir, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6542-925X","authenticated-orcid":false,"given":"Ismail Ertan","family":"Sevin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Ataturk Training and Research Hospital, Izmir Katip Celebi University, 35620 Izmir, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2795-9049","authenticated-orcid":false,"given":"Hasan Kamil","family":"Sucu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Ataturk Training and Research Hospital, Izmir Katip Celebi University, 35620 Izmir, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Gembruch, O., Jabbarli, R., Rashidi, A., Chihi, M., El Hindy, N., Wetter, A., H\u00fctter, B.O., Sure, U., Dammann, P., and \u00d6zkan, N. 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