Differences between subtotal corpectomy and laminoplasty for cervical spondylotic myelopathy

Abstract

Objective: This study aimed to obtain guidelines for choosing between subtotal corpectomy (SC) and laminoplasty (LP) by analysing the surgical outcomes, radiological changes and problems associated with each surgical modality. Study Design: A retrospective analysis of two interventional case series. Setting: Department of Orthopaedic Surgery, Kagawa University, Japan. Methods: Subjects comprised 34 patients who underwent SC and 49 patients who underwent LP. SC was performed by high-speed drilling to remove vertebral bodies. Autologous strut bone grafting was used. LP was performed as an expansive open-door LP. The level of decompression was from C3 to C7. Clinical evaluations included recovery rate (RR), frequency of C5 root palsy after surgery, re-operation and axial pain. Radiographic assessments included sagittal cervical alignment and bone union. Results: Comparisons between the two groups showed no significant differences in age at surgery, preoperative factors, RR and frequency of C5 palsy. Progression of kyphotic changes, operation time and volumes of blood loss and blood transfusion were significantly greater in the SC (two-or threelevel) group. Six patients in the SC group required additional surgery because of pseudoarthrosis, and four patients underwent re-operation because of adjacent level disc degeneration. In the LP group, the problem of elimination of postoperative axial symptoms remains to be solved. Conclusions: The merit of SC is the low frequency of axial symptoms. One-level SC can be considered to have similar degree of invasiveness as LP. Compared with SC, LP is more suitable for elderly patients with multilevel stenosis.

Anterior approach versus posterior approach for the treatment of multilevel cervical spondylotic myelopathy: a systemic review and meta-analysis

“…A further 65 studies were subsequently excluded for the following reasons: single level CSM (n = 14); mean cervical kyphosis [15°( n = 1); OPLL related cervical myelopathy (n = 13); combination of anterior and posterior surgical approaches used (n = 5); different surgical indications between groups (n = 7); and non-controlled studies (n = 25). Hence, a total of 8 studies were included in the meta-analysis [21][22][23][24][25][26][27][28]. The detail selection process is shown in Fig.…”

“…Hirai et al [27] Liu et al [25] Shibuya et al [28] Wada et al [22] Yonenobu et al [21] Total (95% CI)…”

“…Hirai et al [27] Liu et al [25] Shibuya et al [28] Yonenobu et al [21] Total (95% CI) Heterogeneity: Chi² = 15.65, df = 3 (P = 0.001); I² = 81% Test for overall effect: Z = 1.31 (P = 0. 19 Fig.…”

Efficacy of intraoperative monitoring of transcranial electrical stimulation–induced motor evoked potentials and spontaneous electromyography activity to identify acute-versus delayed-onset C-5 nerve root palsy during cervical spine surgery

“…3,4,[7][8][9]14,16,18,19,24,25 For both single-and multilevel anterior procedures involving the C-4 and C-5 spinal levels, but without corpectomy, the incidence of C-5 nerve root injury was ≤ 1%. The incidence of weakness in patients who had undergone a corpectomy at C-4 but not at C-5 or at C-5 but not at C4 was similar to rates reported in the literature for anterior cervical spine surgeries.…”

“…The incidence of weakness in patients who had undergone a corpectomy at C-4 but not at C-5 or at C-5 but not at C4 was similar to rates reported in the literature for anterior cervical spine surgeries. 1,9,14,18,24,25 Authors of previous studies 1,9 have noted that increasing the number of levels decompressed during anterior spine surgery increases the risk of C-5 injury. Our results are consistent with those findings and suggest, moreover, that C-4 and C-5 corpectomies are associated with a much higher incidence of C-5 palsy than discectomies spanning the same levels.…”