Intra- and Post-Complications of Cervical Laminoplasty for the Treatment of Cervical Myelopathy

Abstract

Study Design. Retrospective database study. Objective. To assess the intra- and postoperative complications of cervical laminoplasty and to evaluate the effect of intraoperative neuromonitoring use on postoperative limb paralysis incidence. Summary of Background Data. Cervical laminoplasty is a known procedure for the management of cervical spondylotic myelopathy (CSM). Methods. This was a retrospective study of 532 patients with CSM who underwent cervical laminoplasty between 2007 and the first quarter of 2016 using the Humana subset of the PearlDiver Database. The database was queried using the relevant International Classification of Diseases (ICD-9 and ICD-10) codes for CSM and Current Procedural Terminology (CPT) codes for cervical laminoplasty. The intra- and postoperative incidence of surgical and medical complications and reoperations was then determined and was compared with a propensity score-matched cohort of patients who had posterior laminectomy and fusion (490 patients in each group), using multivariate logistic regression analysis. Results. Laminoplasty was associated with a lower incidence of dysphagia (odds ratio [OR] = 0.37, 95% confidence interval [CI] = 0.16–0.79; P = 0.014), 30-day readmission (OR = 0.51, 95% CI = 0.35–0.75; P < 0.001), urinary tract infection (OR = 0.58, 95% CI = 0.37–0.93; P = 0.023), and incision and drainage, exploration or evacuation (OR = 0.28, 95% CI = 0.08–0.79; P = 0.026). The use of intraoperative neuromonitoring was associated with a non-significant lower incidence of limb paralysis within 1 and 3 months postoperatively (OR = 0.52 and 0.51, 95% CI = 0.23–1.19 and 0.23–1.11; P = 0.119 and 0.091, respectively). Conclusion. Compared with posterior laminectomy and fusion, laminoplasty had lower rates of dysphagia, urinary tract infection, and 30-day readmission. The use of intraoperative neuromonitoring was associated with a lower risk of postoperative limb paralysis, but it did not achieve statistical significance. Level of Evidence: 4

Cervical Laminoplasty Versus Posterior Laminectomy and Fusion: Trends in Utilization and Evaluation of Complication and Revision Surgery Rates

“…This study demonstrated that over time, the rates of LP have remained constant compared with LF, despite an increasing prevalence of published literature supporting LP as a treatment option for CSM. 14-17 This is consistent with previous studies that have suggested that LP is an underutilized procedure based on radiographic criteria. 18…”

“…However, more recent literature supports comparable and even lower rates of axial neck pain after LP. 15,[26][27][28][29][30][31][32] Our study found notable baseline differences in the rates of preoperative axial neck pain, with more patients in the LF having axial neck pain compared with LP patients. This is likely due to the previously held belief discussed above that questioned the effectiveness of LP in patients with pre-existing axial neck pain.…”

Perioperative Complications of Surgery for Degenerative Cervical Myelopathy: A Comparison Between 3 Procedures

“…The lower incidence in laminoplasty may be attributed to the preserved cervical motion in laminoplasty compared to the loss of motion associated with fusion procedures. 41 - 43 Excessive distraction of the disc space during ACDF could result in stretching the posterior ligaments and facet joint injury, which may lead to subsequent postoperative neck pain. 44 Choi et al 45 reported postoperative intractable cervicalgia following ACDF.…”

Cervical alignment and clinical outcome of anterior decompression with fusion vs. posterior decompression with fixation in kyphotic cervical spondylotic myelopathy

“…Whether anterior or posterior approach is performed, the key point for the surgeon is spinal cord decompression with special attention to avoid iatrogenic spinal cord injury. Intraoperative neuromonitoring (IONM), including motor evoked potentials (MEPs), somatosensory evoked potentials (SSEPs), and electromyography (EMG), had gained popularity for the potential detection of neurological injury during spinal surgery ( Mesregah et al, 2020 ). IONM afforded the surgical team an opportunity to perform rapid intervention and prevent injury progression or possibly to reverse impending neurological sequelae.…”