Getting Down to the Bare Bones: Does laminoplasty or laminectomy With Fusion Provide Better Outcomes for Patients With Multilevel Cervical Spondylotic Myelopathy?

Abstract

Objective: Cervical spondylotic myelopathy (CSM) is a degenerative disorder leading to progressive decline in spinal cord function. Cervical laminoplasty (CLP) and cervical laminectomy with fusion (CLF) are standard treatments for multilevel CSM. However, it is still unclear whether one procedure over the other provides better outcomes. Here, we performed a comprehensive review of published articles that compare the clinical outcomes and costs between CLP and CLF for CSM. Methods: A literature search was performed using PubMed, Web of Science, and Cochrane databases. Strict exclusion criteria were applied, and included articles were then assessed for publication year, study design, and significant differences in outcome variables. Results: From 519 studies identified with search terms, 38 studies were included for the qualitative analysis. Statistically significant differences in the clinical outcomes and costs were found in 18 studies. Eleven studies were prospective or retrospective, and 8 studies were meta-analyses. For the outcome variables of interest, results were reported by classifying into prospective studies, retrospective studies, and meta-analyses. Conclusion: CLP and CLF are 2 of the most commonly performed surgical procedures for the treatment of CSM. Although CLP and CLF each provide satisfactory clinical outcomes for patients with CMS, CLP may result in better cervical range of motion and less cost, length of stay, operation time, blood loss, paraspinal muscular atrophy, and rate of nerve palsies as compared to CLF. The major limitation of CLP versus CLF comparison studies includes the heterogeneity in techniques and preoperative criteria. Thus, further validation and investigations in larger cohorts will be required.

Biomechanical evaluation of reconstruction of the posterior complex in restorative laminoplasty with miniplates

“…Moreover, the advantages of miniplates xation include ease of use and holding the lamina in the almost original position as before until solid bony or strong brous unions obtained. However, the clinical effect of restorative laminoplasty with miniplates xation was limited due to a lack of appropriate internal xation system which could match this technology in practical terms [13,28].…”

“…Approaches for removing the posterior structures for decompression include partial or total laminectomy, and has been widely used in clinical practices [8][9][10][11][12]. However, as the scope of clinical application expanded and the follow-up time increased, its shortcomings gradually emerged [13][14][15]. In the clinical environment, even though laminectomy provides su cient surgical exposure for safe removal of space occupying lesions in the spinal canal, there are still some problems.…”

Nationwide sample data analysis of additional surgery rate after anterior or posterior cervical spinal surgery

“…Additionally, one surgical technique does not fit every case; hence, there should be a trade-off between the positive and negative factors for each surgical technique. Therefore, the surgical decision in cervical spinal surgery is not unanimous and individualized on a case-by-case basis 4,[25][26][27][46][47][48][49] . Nonetheless, a consensus is reached through continued education with research, academic meetings, and correspondence between surgeons.…”

“…When the compressive lesions span more than three levels, posterior cervical surgeries such as laminoplasty or laminectomy with or without instrumented fusion are recommended 19 . For kyphotic cervical spine, anterior cervical surgery or posterior laminectomy with instrumentation is recommended 4 , 20 , 22 , 25 – 27 . Although previous studies have shown similar clinical outcomes between anterior and posterior cervical surgeries, the anterior surgery showed better cervical alignment 1 , 5 – 17 .…”

Anterior and Posterior Approaches for 4-Level Degenerative Cervical Myelopathy: Low-Profile Cage Versus Cervical Pedicle Screws Fixation

“…Surgical decompression can enhance neurological function and prevent future deterioration [ 1 , 2 , 3 ]. Although surgical treatments have greatly enhanced over the last few decades, there is still no consensus approach for treating multilevel DCM (MDCM), particularly 4-level DCM [ 3 , 4 , 5 , 6 ].…”