Laminoplasty versus Laminectomy and Fusion for Multilevel Cervical Spondylotic Myelopathy

Woods, Barrett I.; Hohl, Justin B.; Lee, Joon; Donaldson, William F.; Kang, James D.

doi:10.1007/s11999-010-1653-5

Cited by 115 publications

(108 citation statements)

References 27 publications

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“…These studies were designed to compare the efficacy and complication rates between 2 different surgical interventions or varying techniques. Studies reported on differences between anterior and posterior approaches (n = 9); 15,18,19,22,30,42,44,48,59 laminoplasty and laminectomy and fusion (n = 4); 10,19,70,72 anterior decompression and Bryan disc (n = 1); 11 and anterior cervical discectomy and fusion (ACDF) and corpectomy (n = 2). 47,63 In addition, 11 studies compared laminoplasty techniques or considered technical differences such as laminoplasty with and without foraminotomy or muscle preservation.…”

Section: Study Characteristicsmentioning

confidence: 99%

A systematic review of clinical and surgical predictors of complications following surgery for degenerative cervical myelopathy

Tetreault

Ibrahim

Côté

et al. 2016

SPI

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OBJECT Although generally safe and effective, surgery for the treatment of cervical spondylotic myelopathy (CSM) is associated with complications in 11%–38% of patients. Several predictors of postoperative complications have been proposed but few are used to detect high-risk patients. A standard approach to identifying “at-risk” patients would improve surgeons’ ability to prevent and manage these complications. The authors aimed to compare the complication rates between various surgical procedures used to treat CSM and to identify patient-specific, clinical, imaging, and surgical predictors of complications. METHODS The authors conducted a systematic review of the literature and searched MEDLINE, MEDLINE in Process, EMBASE, and Cochrane Central Register of Controlled Trials from 1948 to September 2013. Cohort studies designed to evaluate predictors of complications and intervention studies conducted to compare different surgical approaches were included. Each article was critically appraised independently by 2 reviewers, and the evidence was synthesized according to the principles outlined by the Grading of Recommendation Assessment, Development and Evaluation (GRADE) Working Group. RESULTS A total of 5472 citations were retrieved. Of those, 60 studies met the inclusion criteria and were included in the review. These studies included 36 prognostic cohort studies and 28 comparative intervention studies. High evidence suggests that older patients are at a greater risk of perioperative complications. Based on low evidence, other clinical factors such as body mass index, smoking status, duration of symptoms, and baseline severity score, are not predictive of complications. With respect to surgical factors, low to moderate evidence suggests that estimated blood loss, surgical approach, and number of levels do not affect rates of complications. A longer operative duration (moderate evidence), however, is predictive of perioperative complications and a 2-stage surgery is related to an increased risk of major complications (high evidence). In terms of surgical techniques, higher rates of neck pain were found in patients undergoing laminoplasty compared with anterior spinal fusion (moderate evidence). In addition, with respect to laminoplasty techniques, there was a lower incidence of C-5 palsy in laminoplasty with concurrent foraminotomy compared with nonforaminotomy (low evidence). CONCLUSIONS The current review suggests that older patients are at a higher risk of perioperative complications. A longer operative duration and a 2-stage surgery both reflect increased case complexity and can indirectly predict perioperative complications.

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Section: Study Characteristicsmentioning

confidence: 99%

A systematic review of clinical and surgical predictors of complications following surgery for degenerative cervical myelopathy

Tetreault

Ibrahim

Côté

et al. 2016

SPI

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“…17 The spinal cord in CSM is compressed because of the degeneration of intervertebral discs and the secondary degeneration of stable structures, such as the uncovertebral joint, facet joint, posterior longitudinal ligament, and ligamentum flavum. 4 Because compressive lesions leading to cervical myelopathy usually arise anteriorly, proponents of anterior surgery cite as advantages the ability to directly remove the majority of compressive lesions in the cervical spine, a muscle-sparing dissection, which results in minimal postoperative pain, and the ability to correct and decompress the cord over kyphotic lesions.…”

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confidence: 99%

Laminoplasty versus laminectomy and fusion for multilevel cervical myelopathy: a meta-analysis of clinical and radiological outcomes

Lee

Kang

et al. 2015

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OBJECT Posterior cervical surgery, expansive laminoplasty (EL) or laminectomy followed by fusion (LF), is usually performed in patients with multilevel (≥ 3) cervical spondylotic myelopathy (CSM). However, the superiority of either of these techniques is still open to debate. The aim of this study was to compare clinical outcomes and postoperative kyphosis in patients undergoing EL versus LF by performing a meta-analysis. METHODS Included in the meta-analysis were all studies of EL versus LF in adults with multilevel CSM in MEDLINE (PubMed), EMBASE, and the Cochrane library. A random-effects model was applied to pool data using the mean difference (MD) for continuous outcomes, such as the Japanese Orthopaedic Association (JOA) grade, the cervical curvature index (CCI), and the visual analog scale (VAS) score for neck pain. RESULTS Seven studies comprising 302 and 290 patients treated with EL and LF, respectively, were included in the final analyses. Both treatment groups showed slight cervical lordosis and moderate neck pain in the baseline state. Both groups were similarly improved in JOA grade (MD 0.09, 95% CI −0.37 to 0.54, p = 0.07) and neck pain VAS score (MD −0.33, 95% CI −1.50 to 0.84, p = 0.58). Both groups evenly lost cervical lordosis. In the LF group lordosis seemed to be preserved in long-term follow-up studies, although the difference between the 2 treatment groups was not statistically significant. CONCLUSIONS Both EL and LF lead to clinical improvement and loss of lordosis evenly. There is no evidence to support EL over LF in the treatment of multilevel CSM. Any superiority between EL and LF remains in question, although the LF group shows favorable long-term results.

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“…Prior reports have documented rates of complications associated with the surgical treatment of CSM, [1][2][3][4][6][7][8]11,12,[14][15][16][18][19][20]31,33 but the data from these reports have key limitations, including retrospective design, [2][3][4]7,8,11,12,[14][15][16][18][19][20]31,33 reporting of a single-surgeon or single-institution experience, 1,2,4,7,8,11,12,14,16,18,19,31 and reliance solely on inpatient ICD-9 codes. 3 In addition, many of these prior reports are based on small numbers of patients, which may be inadequate to estimate rates of less common complications.…”

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confidence: 99%

Perioperative and delayed complications associated with the surgical treatment of cervical spondylotic myelopathy based on 302 patients from the AOSpine North America Cervical Spondylotic Myelopathy Study

Fehlings

Smith

Kopjar³

et al. 2012

SPI

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140

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Object Rates of complications associated with the surgical treatment of cervical spondylotic myelopathy (CSM) are not clear. Appreciating these risks is important for patient counseling and quality improvement. The authors sought to assess the rates of and risk factors associated with perioperative and delayed complications associated with the surgical treatment of CSM. Methods Data from the AOSpine North America Cervical Spondylotic Myelopathy Study, a prospective, multicenter study, were analyzed. Outcomes data, including adverse events, were collected in a standardized manner and externally monitored. Rates of perioperative complications (within 30 days of surgery) and delayed complications (31 days to 2 years following surgery) were tabulated and stratified based on clinical factors. Results The study enrolled 302 patients (mean age 57 years, range 29–86) years. Of 332 reported adverse events, 73 were classified as perioperative complications (25 major and 48 minor) in 47 patients (overall perioperative complication rate of 15.6%). The most common perioperative complications included minor cardiopulmonary events (3.0%), dysphagia (3.0%), and superficial wound infection (2.3%). Perioperative worsening of myelopathy was reported in 4 patients (1.3%). Based on 275 patients who completed 2 years of follow-up, there were 14 delayed complications (8 minor, 6 major) in 12 patients, for an overall delayed complication rate of 4.4%. Of patients treated with anterior-only (n = 176), posterior-only (n = 107), and combined anterior-posterior (n = 19) procedures, 11%, 19%, and 37%, respectively, had 1 or more perioperative complications. Compared with anterior-only approaches, posterior-only approaches had a higher rate of wound infection (0.6% vs 4.7%, p = 0.030). Dysphagia was more common with combined anterior-posterior procedures (21.1%) compared with anterior-only procedures (2.3%) or posterior-only procedures (0.9%) (p < 0.001). The incidence of C-5 radiculopathy was not associated with the surgical approach (p = 0.8). The occurrence of perioperative complications was associated with increased age (p = 0.006), combined anterior-posterior procedures (p = 0.016), increased operative time (p = 0.009), and increased operative blood loss (p = 0.005), but it was not associated with comorbidity score, body mass index, modified Japanese Orthopaedic Association score, smoking status, anterior-only versus posterior-only approach, or specific procedures. Multivariate analysis of factors associated with minor or major complications identified age (OR 1.029, 95% CI 1.002–1.057, p = 0.035) and operative time (OR 1.005, 95% CI 1.002–1.008, p = 0.001). Multivariate analysis of factors associated with major complications identified age (OR 1.054, 95% CI 1.015–1.094, p = 0.006) and combined anterior-posterior procedures (OR 5.297, 95% CI 1.626–17.256, p = 0.006). Conclusions For the surgical treatment of CSM, the vast majority of complications were treatable and without long-term impact. Multivariate factors associated with an increased risk of complications include greater age, increased operative time, and use of combined anterior-posterior procedures.

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Laminoplasty versus Laminectomy and Fusion for Multilevel Cervical Spondylotic Myelopathy

Abstract: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Cited by 115 publications

References 27 publications

A systematic review of clinical and surgical predictors of complications following surgery for degenerative cervical myelopathy

A systematic review of clinical and surgical predictors of complications following surgery for degenerative cervical myelopathy

Laminoplasty versus laminectomy and fusion for multilevel cervical myelopathy: a meta-analysis of clinical and radiological outcomes

Perioperative and delayed complications associated with the surgical treatment of cervical spondylotic myelopathy based on 302 patients from the AOSpine North America Cervical Spondylotic Myelopathy Study

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