Comparison of Functional and Radiological Outcomes Between Two Posterior Approaches in the Treatment of Multilevel Cervical Spondylotic Myelopathy

Abstract

Background:Posterior cervical decompression is an accepted treatment for multilevel cervical spondylotic myelopathy (CSM). Each posterior technique has its own advantages and disadvantages. In the present study, we compared the functional and radiological outcomes of expansive hemilaminectomy and laminoplasty with mini titanium plate in the treatment of multilevel CSM.Methods:Forty-four patients with multilevel CSM treated with posterior cervical surgery in Department of Orthopedic Surgery, Beijing Army General Hospital from March 2011 to June 2012 were enrolled in this retrospective study. Patients were divided into two groups by surgical procedure: Laminoplasty (Group L) and hemilaminectomy (Group H). Perioperative parameters including age, sex, duration of symptoms, operative duration, and intraoperative blood loss were recorded and compared. Spinal canal area, calculated using AutoCAD® software (Autodesk Inc., San Rafael, CA, USA), and neurological improvement, evaluated with Japanese Orthopedic Association score, were also compared.Results:Neurological improvement did not differ significantly between groups. Group H had a significantly shorter operative duration and significantly less blood loss. Mean expansion ratio was significantly greater in Group L (77.83 ± 6.41%) than in Group H (62.72 ± 3.86%) (P < 0.01).Conclusions:Both surgical approaches are safe and effective in treating multilevel CSM. Laminoplasty provides a greater degree of enlargement of the spinal canal, whereas expansive hemilaminectomy has the advantages of shorter operative duration and less intraoperative blood loss.

Laminectomy and fusion vs laminoplasty for multi-level cervical myelopathy: a systematic review and meta-analysis

“…After detailed evaluation of these articles, 47 studies remained for detailed assessment. After applying selection criteria, 10 studies [5,[14][15][16][17][18][19][20][21][22] were selected for analysis ( Fig. 1).…”

“…From these 10 included studies, there were 335 patients who underwent laminectomy and fusion compared to 320 patients who underwent extended laminoplasty. Of these, two studies were prospective randomized trials [17,22] whilst the remainder [5,[14][15][16][18][19][20][21] were retrospective observational studies.…”

“…Table 3 Risk of assessment of non-randomized controlled studies using the checklist by Cowley et al [13] Risk of bias assessment of included observational studies using the checklist by Cowley et al [13] Criteria Ren et al [18] Lee et al [16] Yang et al [21] Du et al [15] Chen et al [14] Zhang (2012) Highsmith et al [5] Woods et al [20] Sivaraman et al [19] Method of selection of patients identified and appropriate Eur Spine J…”

Anterior cervical discectomy and fusion vs posterior laminoplasty for the treatment of myelopathy due to two-level localized ossification of the posterior longitudinal ligament

“…Shamji et al [ 15 ] conducted a nationwide database study on the length and cost of anterior and posterior approaches, and the anterior approach was found to be associated with less hospitalization and lower cost. Lau et al [ 16 ] and Ren et al [ 17 ] reported that the operation time and blood loss associated with ACDF were less than those associated with laminoplasty. This is because it takes a long time to detach the paracervical muscle from the lamina in a laminoplasty, resulting in more blood loss.…”

Management of patients with cervical myelopathy

“…This approach is initially chosen in the following situations: disease affecting more than three levels, primary posterior pathology, congenital cervical stenosis, or in case of ossification of posterior longitudinal ligament or yellow ligament [11,13,14]. Kyphotic alignment of the cervical spine is a contraindication to this surgery.…”