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

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>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.</jats:p></jats:sec>

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

“…There was no significant difference in JOA and VAS scores, with the assessment of CCI revealing comparable outcomes between the two surgical approaches. These results were consistent with a prior review and meta-analysis [23], which concluded that LF and EL lead to equivalent clinical improvement and loss of lordosis. The authors included that there is no evidence to support EL over LF in the treatment of multi-level CSM; however, the relative complication rates between the two approaches was not clearly established.…”

Regression of Disc-Osteophyte Complexes Following Laminoplasty Versus Laminectomy with Fusion for Cervical Spondylotic Myelopathy

“…A 2015 meta-analysis demonstrated that some loss of lordosis occurs following LF and laminoplasty, with similar clinical outcomes from either procedure. 21 Another study examined the role of sagittal alignment in precluding laminoplasty, with no correlation between sagittal alignment and outcome. 11 The reasons for these discordances are unclear.…”

Laminoplasty with lateral mass screw fixation for cervical spondylotic myelopathy in patients with athetoid cerebral palsy

“…[8] Laminoplasty is an option for decompressing multilevel cervical spinal canal stenosis. [16,25] Some reports have recommended laminoplasty without fusion as a better option in patients with multilevel spinal stenosis and/or cervical lordosis. [26–28] Even if the laminoplasty has a restrictive effect on intervertebral mobility regarding the decreased range of motion of the cervical spine, [29,30] the results of laminoplasty without spinal fusion for CSM in patients with ACP are unsatisfactory.…”