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BACKGROUND
Laminectomy and multilevel fusion in patients with degenerative cervical myelopathy lead to severe restriction in cervical spine mobility. Since fusions from C to the thoracic spine result in a permanently stiff subaxial cervical spine, it seems obvious to restore physiological cervical lordosis, especially with regard to sagittal balance. However, there are reports that a fusion in a more lordotic position leads to a reduction of rotational cervical range of motion in the still mobile segments C-C. This study investigates the relationship between postoperative cervical lordosis and the objective rotational range of motion and subjective restriction.

METHODS
In this single-center, retrospective cohort study, patients with degenerative cervical myelopathy operated via laminectomy and fusion from C to the thoracic spine were included. X-ray imaging was evaluated for common lordosis parameters. The patient-reported rotational restriction of cervical spine mobility was acquired by a five-step score. Objective rotational range of motion was measured. The radiological parameters for cervical lordosis (C-C lordotic angle, C-C Cobb angle) were correlated with the measurements and the patient-reported subjective scores.

FINDINGS
We found a significant, medium negative correlation between the measurements for rotation and the C-C lordotic angle and a significant, large negative correlation to the C-C Cobb angle. For subjective restriction, no or only small correlation was observed.

INTERPRETATION
We found significant negative correlations between radiological cervical lordosis and objective measurements for rotation. These results indicate that for this particular patient population, a stronger postoperative cervical lordosis does not seem favorable under the aspect of rotational range of motion.