Laminoplasty Versus Laminectomy and Fusion for Multilevel Cervical Myelopathy

Heller, John G.; Edwards, Charles C.; Murakami, Hideki; Rodts, Gerald E.

doi:10.1097/00007632-200106150-00013

Cited by 307 publications

(212 citation statements)

References 41 publications

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“…Both laminectomy and laminoplasty are safe and effective treatments for cervical myelopathy [4,5,14]. As laminoplasty is less destructive to posterior tissues than laminectomy, the more opportunity for muscles to be reattached to bone and the more preservation of bony covering of the dura mater in laminoplasty may contribute to less postoperative axial pain.…”

Section: Discussionmentioning

confidence: 99%

Axial pain after posterior cervical spine surgery: a systematic review

et al. 2010

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Posterior operative approach has been the standard treatment for cervical compressive myelopathy, and axial pain after laminoplasty or laminectomy as a postoperative complication is now gradually receiving more and more attention. The objective of this study was to provide a systematic review of the current understanding of axial pain after cervical laminoplasty and laminectomy, and summarize clinical features, influence factors and preventive measures of axial pain after posterior decompressive surgery based on a review of literature published in the English language. Axial pain distributes over nuchal, periscapular and shoulder regions. Posterior surgery is not the major cause of axial pain, but axial pain can be worsened by the procedure. There are many clinical factors that influence postoperative axial pain such as age, preoperative axial pain, different surgical technique and postoperative management, but most of them are still controversial. Several surgical modifications have been innovated to reduce axial pain. Less invasive surgery, reconstruction of the extensor musculature, avoiding detachment of the semispinalis cervicis muscle and early removal of external immobilization have proved to be effective. Axial pain is under the influence of multiple factors, so comprehensive methods are required to reduce and avoid the postoperative axial pain. Because of methodological shortcomings in publications included in this systematic review, different results from different studies may be produced due to differences in study design, evaluation criteria, sample size, and incidence or severity of axial pain. More high-quality studies are necessary for drawing more reliable and convincing conclusions.

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Section: Discussionmentioning

confidence: 99%

Axial pain after posterior cervical spine surgery: a systematic review

et al. 2010

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“…12,22,28 Although laminoplasty has advantages such as a lower incidence of postoperative cervical kyphosis and preservation of range of motion (ROM), many authors have reported a significant decrease in cervical ROM after laminoplasty despite the good postoperative neurological improvements experienced by their patients. [1][2][3][4][5][6]11,12,[15][16][17][18][20][21][22]25,26,28 However, they have investigated using only 2D flexion and extension on lateral radiographs. To our knowledge, there has been no report of 3D motion analysis about cervical laminoplasty, including coupled motion and precise intervertebral motion.…”

mentioning

confidence: 99%

In vivo 3D kinematic changes in the cervical spine after laminoplasty for cervical spondylotic myelopathy

Nagamoto

Iwasaki

Sugiura

et al. 2014

SPI

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Object Cervical laminoplasty is an effective procedure for decompressing the spinal cord at multiple levels, but restriction of neck motion is one of the well-known complications of the procedure. Although many authors have reported on cervical range of motion (ROM) after laminoplasty, they have focused mainly on 2D flexion and extension on lateral radiographs, not on 3D motion (including coupled motion) nor on precise intervertebral motion. The purpose of this study was to clarify the 3D kinematic changes in the cervical spine after laminoplasty performed to treat cervical spondylotic myelopathy. Methods Eleven consecutive patients (6 men and 5 women, mean age 68.1 years, age range 57–79 years) with cervical spondylotic myelopathy who had undergone laminoplasty were included in the study. All patients underwent 3D CT of the cervical spine in 5 positions (neutral, 45° head rotation left and right, maximum head flexion, and maximum head extension) using supporting devices. The scans were performed preoperatively and at 6 months after laminoplasty. Segmental ROM from Oc–C1 to C7–T1 was calculated both in flexion-extension and in rotation, using a voxel-based registration method. Results Mean C2–7 flexion-extension ROM, equivalent to cervical ROM in all previous studies, was 45.5° ± 7.1° preoperatively and 35.5° ± 8.2° postoperatively, which was a statistically significant 33% decrease. However, mean Oc–T1 flexion-extension ROM, which represented total cervical ROM, was 71.5° ± 8.3° preoperatively and 66.5° ± 8.3° postoperatively, an insignificant 7.0% decrease. In focusing on each motion segment, the authors observed a statistically significant 22.6% decrease in mean segmental ROM at the operated levels during flexion-extension and a statistically insignificant 10.2% decrease during rotation. The most significant decrease was observed at C2–3. Segmental ROM at C2–3 decreased 24.2% during flexion-extension and 21.8% during rotation. However, a statistically insignificant 37.2% increase was observed at the upper cervical spine (Oc–C2) during flexion-extension. The coupling pattern during rotation did not change significantly after laminoplasty. Conclusions In this first accurate documentation of 3D segmental kinematic changes after laminoplasty, Oc–T1 ROM, which represented total cervical ROM, did not change significantly during either flexion-extension or rotation by 6 months after laminoplasty despite a significant decrease in C2–7 flexion-extension ROM. This is thought to be partially because of a compensatory increase in segmental ROM at the upper cervical spine (Oc–C2).

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“…6,11,14,21,23,25,28,29 This large range in nonunion rates reflect variation in patient comorbidities, surgical indications, number of cervical spine levels fused, and the type of instrumentation and bone graft used. The introduction of lateral mass screw-rod fixation systems have biomechanically allowed a more rigid fixation for early bone fusions in the cervical spine.…”

Section: Discussionmentioning

confidence: 99%

Reoperation rates for symptomatic nonunions in posterior cervical (subaxial) fusions with and without bone morphogenetic protein in a cohort of 1158 patients

Guppy

Harris

Chen

et al. 2016

SPI

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OBJECTIVE Bone morphogenetic protein (BMP) was first approved in 2002 for use in single-level anterior lumbar fusions as an alternative to iliac crest grafts. Subsequent studies have concluded that BMP provides superior fusions rates and therefore reduces reoperations for nonunions. The purpose of this study was to determine the reoperation rates for symptomatic nonunions in posterior cervical (subaxial) spinal fusions with and without the use of BMP and to determine if the nonunion rates are statistically significantly different between the two groups. METHODS Between January 2009 and September 2013, the authors identified 1158 posterior cervical spinal fusion cases in the subaxial spine (C2–7) from a large spine registry (Kaiser Permanente). Patient characteristics, diagnoses, operative times, lengths of stay, and reoperations were extracted from the registry. Reoperations for symptomatic nonunions were adjudicated via chart review. Logistic regression was conducted to produce estimates of odds ratios (OR) and 95% confidence intervals (CIs). Kaplan-Meier curves for the non-BMP and BMP groups were generated and compared using the log-rank test. RESULTS In this cohort there were 1158 patients (19.3% with BMP) with a median follow up of 1.7 years (interquartile range [IQR] 0.7–2.9 years) and median duration to operative nonunion of 0.63 years (IQR 0.44–1.57 years). Kaplan-Meier curves showed no significant difference in reoperation rates for nonunions using the log-rank test (p = 0.179). In a subset of patients with more than 1 year of follow-up, 788 patients were identified (22.5% with BMP) with a median follow-up duration of 2.5 years (IQR 1.7–3.4 years) and a median time to operative nonunion of 0.73 years (IQR 0.44–1.57 years). There was no statistically significant difference in the symptomatic operative nonunion rates for posterior cervical (subaxial) fusions with BMP compared with non-BMP (1.1% vs 0.7%; crude OR 1.73, 95% CI 0.32–9.55, p = 0.527) for more than 1 year of follow-up. CONCLUSIONS This study presents the largest series of patients using BMP in posterior cervical (subaxial) spinal fusions. Reoperation rates for symptomatic nonunions with more than 1 year of follow-up were found to be 1.1% with BMP and 0.7% without BMP. There was no significant difference in the reoperation rates for symptomatic nonunions with or without BMP.

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Laminoplasty Versus Laminectomy and Fusion for Multilevel Cervical Myelopathy

Abstract: The marked difference in complications and functional improvement between these matched cohorts suggests that laminoplasty may be preferable to laminectomy with fusion as a posterior procedure for multilevel cervical myelopathy.

Cited by 307 publications

References 41 publications

Axial pain after posterior cervical spine surgery: a systematic review

Axial pain after posterior cervical spine surgery: a systematic review

In vivo 3D kinematic changes in the cervical spine after laminoplasty for cervical spondylotic myelopathy

Reoperation rates for symptomatic nonunions in posterior cervical (subaxial) fusions with and without bone morphogenetic protein in a cohort of 1158 patients

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