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

Phan, Kevin; Scherman, Daniel; Xu, Joshua; Leung, Vannessa; Virk, Sohaib; Mobbs, Ralph J.

doi:10.1007/s00586-016-4671-5

Cited by 55 publications

(62 citation statements)

References 40 publications

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“…LP and LF both increased the volume of the spinal canal, relieved spinal cord compression, and did not cause cervical spine instability. Many studies have proven that LF and LP are both safe and effective [3,4,11,17,23]. Our results also show no signi cant difference in the JOA score, VAS-N score, SF-36 MCS or SF-36 PCS between the two groups at the nal follow-up visit.…”

Section: Discussionsupporting

confidence: 62%

“…LF and LP are the common treatments for MCSM [23]. A number of previous studies have proven that as a treatment option of MCSM, both methods can improve the symptoms and prevent further deterioration of the nervous system with no difference in e cacy [3,11,17,23]. However, ISI on T2WI underwent laminoplasty has been reported to be associated with poor surgical outcomes [10].…”

Section: Discussionmentioning

confidence: 99%

“…The patients were chosen according to the following inclusion and exclusion criteria. Inclusion criteria: (1) Features conformed to the diagnostic criteria of MCSM [11,12]; (2) MRI examination of the cervical spine showed ISI on T2WI; (3) age >18 years; (4) surgery performed by the same surgical team; and (5) positive 'K-line' [13]. Exclusion criteria: (1) Cervical congenital malformations and syringomyelia; (2) cervical cancer;…”

Section: Patient Selectionmentioning

confidence: 99%

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Is Laminectomy and Fusion the Better Choice than Laminoplasty for Multilevel Cervical Myelopathy with Signal Changes on Magnetic Resonance Imaging ? A Comparison of Two Posterior Surgeries

Zhang

Liu

et al. 2020

Preprint

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Abstract Background This study aimed to compare the clinical outcomes and complications between laminectomy and fusion (LF) and laminoplasty (LP) for multi-level cervical spondylotic myelopathy (MCSM) with increased signal intensity (ISI) on T2-weighted images (T2WI).Methods In this retrospective cohort study, we analyzed 52 patients with MCSM with ISI on T2WI who underwent laminoplasty (LP group). The Japanese Orthopedic Association (JOA) score, the Visual Analogue Scale (VAS) score, the physical and mental component scores (PCS and MCS) of Short-Form 36 (SF-36), and the extension and flexion ranges of motion (ROMs) were recorded. As controls, propensity score matching identified 52 patients who underwent laminectomy and fusion (LF group) from January 2014 to June 2016 using 7 independent variables (preoperation): age, sex, JOA score, SF-36 PCS, SF-36 MCS, preoperative symptom duration and high signal intensity ratio (HSIR).Results The operative duration in the LF group was significantly higher than that in the LP group. At the last follow-up, the JOA score, VAS score, and SF-36 (PCS and MCS) scores were all significantly improved in both groups. The extension and flexion ROMs were decreased in both groups but significantly better in the LP group than in the LF group. Both groups demonstrated similar clinical improvements at the final follow-up. The complication rate was higher in the LF group.Conclusion The present study demonstrates that LP for MCSM with ISI on T2WI achieves similar clinical improvement as LF. However, longer operative durations, higher complication rates and lower extension and flexion ROMs were found in the LF group.

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Section: Discussionsupporting

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Section: Patient Selectionmentioning

confidence: 99%

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Is Laminectomy and Fusion the Better Choice than Laminoplasty for Multilevel Cervical Myelopathy with Signal Changes on Magnetic Resonance Imaging ? A Comparison of Two Posterior Surgeries

Zhang

Liu

et al. 2020

Preprint

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“…4,6 In a recent systematic review and meta-analysis, clinical outcomes were similar when comparing laminoplasty to laminectomy with fusion, whereas some independent studies have demonstrated superior clinical outcomes and subjective improvement with decreased complications following laminoplasty when performed on a neutral or kyphotic cervical spine. 4,7 Evidence suggests that motion is preserved. Machino et al 5 reported that 87.9% of cervical range of motion was preserved.…”

Section: Introductionmentioning

confidence: 99%

Reoperation Rates Following Open-Door Cervical Laminoplasty

et al. 2018

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Background: Laminoplasty is a safe and effective procedure for multilevel degenerative cervical stenosis causing myelopathy, that allows for motion preservation. The purpose of this study was to determine the reoperation rate and associated risk factors after cervical laminoplasty.Methods: We present a retrospective consecutive series of patients who underwent a laminoplasty procedure between January 1, 2005, and October 31, 2012, and had a minimum 2-year follow-up. Demographic data were collected and operative records were reviewed to determine the cervical levels involved in the laminoplasty procedure, any concomitant procedures, and estimated blood loss. Clinical records were reviewed and telephone interviews were conducted on those patients with less than 2-year in-person follow-up. Patients requiring reoperations and the reason for the reoperations were determined, as well as the incidence of postoperative C5 palsy.Results: A total of 222 of 266 patients (83%) with a minimum 2-year follow-up had an average follow-up of 4.97 years. Overall, 26 patients underwent 30 reoperations (13.5%). A total of 15 patients underwent 16 reoperations (7.2%) in the acute postoperative period for infection requiring at least 1 irrigation and debridement, hardware-related issues, or posterior cervical wound issues. A total of 13 patients had 14 reoperations (6.3%) outside of the acute postoperative period for the development of a new radiculopathy, recurrent myelopathy, neurologic symptoms with a kyphotic deformity, or a posttraumatic focal kyphotic deformity. Patients who had a concomitant laminectomy demonstrated a significantly (P ¼ .03) higher reoperation rate than those who did not. There were no other statistically significant associations. The C5 palsy rate was 8.1% (18 of 222).Conclusions: Although the preserved motion following laminoplasty may allow for the development of new neurologic symptoms, the reoperation rate continues to compare favorably with laminectomy and fusion and remains a reasonable option for the surgical management of multilevel cervical stenosis causing myelopathy.Level of Evidence: 4. Cervical Spine

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“…The statistics have been described elsewhere. 20 – 25 Briefly, the mean difference (MD) and relative risk (RR) were used as a summary statistic. In the present study, both fixed- and random-effect models were tested.…”

Section: Methodsmentioning

confidence: 99%

Posterolateral Fusion Versus Interbody Fusion for Degenerative Spondylolisthesis: Systematic Review and Meta-Analysis

Campbell

Mobbs

et al. 2017

Global Spine Journal

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Study Design:Systematic review and meta-analysis.Objective:Current surgical management of degenerative spondylolisthesis (DS) involves decompression of the spinal canal followed by fusion with or without interbody. The additional functional and operative benefits derived from interbody inclusion has yet to be thoroughly established with a number of recent studies producing conflicting results. Thus, we aim to compare the functional and operative outcomes after fusion against interbody fusion in the treatment of DS.Methods:This systematic review of the literature comparing posterolateral fusion (PLF) and posterior lumbar interbody fusion (PLIF) outcomes in the treatment of DS was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic searches of 6 databases yielded 386 articles from database inception to July 2016, which were screening against established criteria for inclusion into this study.Results:A total of 6 studies, satisfied criteria and reported outcomes for 721 patients. Fusion alone was performed in 458 (63.5%) patients and interbody fusion was performed in 263 (36.5%) patients. Functional outcomes Oswestry Disability Index (P = .29) and visual analog scale (P = .13) were not statistically different between the 2 approaches. Furthermore, there was no significant inferiority between fusion alone and with interbody in terms of the operative outcomes of blood loss (P = .38), reoperation rate (P = .66), hospital stay (P = .96), complication rate (P = .78), or fusion rate (P = .15).Conclusions:There was no statistically significant difference in functional and operative outcomes following fusion alone versus with interbody. Additional subgroup analysis of intrinsic DS features in future large, prospective, randomized controlled trials will improve the validity of these findings.

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

Cited by 55 publications

References 40 publications

Is Laminectomy and Fusion the Better Choice than Laminoplasty for Multilevel Cervical Myelopathy with Signal Changes on Magnetic Resonance Imaging ? A Comparison of Two Posterior Surgeries

Is Laminectomy and Fusion the Better Choice than Laminoplasty for Multilevel Cervical Myelopathy with Signal Changes on Magnetic Resonance Imaging ? A Comparison of Two Posterior Surgeries

Reoperation Rates Following Open-Door Cervical Laminoplasty

Posterolateral Fusion Versus Interbody Fusion for Degenerative Spondylolisthesis: Systematic Review and Meta-Analysis

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