Abstract
Posterior cervical laminoplasty is a well-established surgical treatment for multilevel cervical spondylotic myelopathy (CSM). However, its application in patients with concomitant cervical kyphotic deformity remains a subject of significant debate and controversy. This review aims to critically examine and synthesize the current evidence surrounding key controversies in the use of laminoplasty for CSM with kyphosis. Specifically, it focuses on: (1) the ongoing debates regarding surgical indications and approach selection criteria, including the roles of cervical alignment (both global and segmental), spinal canal occupancy ratio, and the K-line; (2) the comparative safety profile of posterior versus anterior decompression; (3) the impact of the procedure on postoperative cervical sagittal balance and the risk factors for alignment loss; and (4) the relationship between preoperative cervical alignment and the development of postoperative axial symptoms. The evidence synthesized suggests that mild kyphosis may not preclude successful outcomes with laminoplasty, provided that meticulous patient selection is performed based on a comprehensive assessment of radiographic and clinical factors. Future studies should incorporate dynamic imaging, long-term follow-up, and refined biomechanical models to clarify decompression mechanisms and optimize surgical decision making for this complex patient population.