Is Fixation Procedure Necessary in Posterior Approach Surgery for Cervical Stenosis with Non-Severe Kyphosis?

Objectives To evaluate whether the fixation procedure is essential in posterior surgery for cervical stenosis with non-severe kyphosis. Methods A total of 109 patients diagnosed with cervical stenosis and non-severe kyphosis were included in this study. Patients were categorized based on the surgical approach into those who underwent laminoplasty (LP) alone and those who received fixation with either lateral mass screws (LMS) or pedicle screws (PS). Preoperative and postoperative assessments included the Visual Analog Scale (VAS) for neck pain, the modified Japanese Orthopaedic Association (mJOA) score, the Neck Disability Index (NDI), and the Short Form 36 (SF36) health survey. Sagittal parameters were measured using lateral cervical radiographs. Additionally, hospitalization data, surgical details, and complications were collected. Results No significant differences were observed in baseline demographic characteristics among the three groups. However, the PS group had significantly longer operative duration and greater intraoperative blood loss compared to the others groups. Postoperative mJOA scores improved significantly in all groups. However, the PS group had significantly lower follow-up mJOA scores (12.8 ± 2.9) compared to the LP (15.4 ± 1.7, P < 0.001) and LMS groups (15.6 ± 1.5, P = 0.002). VAS scores demonstrated significant pain reduction in the PS group (preoperative 3.8 ± 2.2 vs. follow-up 2.6 ± 1.8, P = 0.046), whereas changes in the LP (-0.2 ± 2.8, P = 0.877) and LMS groups (-0.3 ± 2.7, P = 0.877) were minimal. The PS group achieved the most pronounced correction in C2-7 Cobb angle (8.6 ± 11.7°) during surgeries. The LMS group did not achieve significant kyphosis correction, with a postoperative improvement in C2-7 Cobb angle of only 3.4 ± 7.7°, comparable to the LP group (3.8 ± 7.8°, P = 0.840). The overall complication rate was highest in the PS group (27.8%), followed by the LMS group (16.0%) and the LP group (9.1%). Conclusion This study suggests that fixation may not be essential in posterior surgery for cervical stenosis with non-severe kyphosis. Posterior surgeries without fixation were associated with shorter operative times, reduced blood loss, comparable neurological recovery and quality of life outcomes to those with fixation, as well as a lower incidence of postoperative complications.