Laminectomy alone versus laminectomy with fusion for degenerative cervical myelopathy: a long-term study of a national cohort

Abstract

Purpose To compare patient-reported 5-year clinical outcomes between laminectomy alone versus laminectomy with instrumented fusion in patients with degenerative cervical myelopathy in a population-based cohort. Methods All patients in the national Swedish Spine Register (Swespine) from January 2006 until March 2019, with degenerative cervical myelopathy, were assessed. Multiple imputation and propensity score matching based on clinicodemographic and radiographic parameters were used to compare patients treated with laminectomy alone with patients treated with laminectomy plus posterior-lateral instrumented fusion. The primary outcome measure was the European Myelopathy Score, a validated patient-reported outcome measure. The scale ranges from 5 to 18, with lower scores reflecting more severe myelopathy. Results Among 967 eligible patients, 717 (74%) patients were included. Laminectomy alone was performed on 412 patients (mean age 68 years; 149 women [36%]), whereas instrumented fusion was added for 305 patients (mean age 68 years; 119 women [39%]). After imputation, the propensity for smoking, worse myelopathy scores, spondylolisthesis, and kyphosis was slightly higher in the fusion group. After imputation and propensity score matching, there were on average 212 pairs patients with a 5-year follow-up in each group. There were no important differences in patient-reported clinical outcomes between the methods after 5 years. Due to longer hospitalization times and implant-related costs, the mean cost increase per instrumented patient was approximately $4700 US. Conclusions Instrumented fusions generated higher costs and were not associated with superior long-term clinical outcomes. These findings are based on a national cohort and can thus be regarded as generalizable.

Unilateral Biportal Endoscopic Laminectomy for Treating Cervical Stenosis: A Technical Note and Preliminary Results

“…In a two-year follow-up study, conventional laminectomy with instrumented fusion and laminectomy alone in degenerative cervical myelopathy (DCM) revealed similar effectiveness [ 18 ]. Dios compared patient-reported 5-year clinical results between conventional laminectomy alone and laminectomy with instrumented fusion in patients with DCM and found no important differences [ 19 ]. A recent narrative review concluded that conventional laminectomy alone was an effective treatment without the additional risks of posterior instrumentation in highly selected patients with normal preoperative cervical sagittal alignment [ 20 ].…”

Comparison of posterior muscle-preserving selective laminectomy and laminectomy with fusion for treating cervical spondylotic myelopathy: study protocol for a randomized controlled trial

“…Based on data from the national Swedish spine registry on patients with CSM, reoperation was estimated to 3.4% after standalone laminectomy and 7.9% after laminectomy and fusion. Five year mortality was estimated to 16.3% in the same population (35) .…”

Improvement rates, adverse events and predictors of clinical outcome following surgery for degenerative cervical myelopathy

“…This study is a retrospective post hoc analysis of a previously published cohort of 717 patients surgically treated for DCM with LAM or LAM + F at the 18 major spine centers in Sweden since the registration started in January 2006 until March 2019. The previous study focused on efficacy and cost-effectiveness [8].…”

“…Nonetheless, the prognostic implications of these predictors are poorly understood, as is the value of adding a posterolateral instrumented fusion to a laminectomy. Although older studies present high rates of post-laminectomy kyphosis potentially advocating prophylactic fusion [7], modern studies indicate no clinical advantage of adding fusion to laminectomy [8][9][10]. Furthermore, fusion surgery itself may lead as frequently as laminectomy to kyphosis at the proximal or distal junction [11].…”