Laminoplasty versus Laminectomy in the Treatment of Primary Spinal Cord Tumors in Adult Patients: A Systematic Review and Meta-analysis of Observational Studies

Abstract

The present systematic review and meta-analysis was conducted to compare the safety and efficacy of the two approaches for primary spinal cord tumors (PSCTs) in adult patients (laminoplasty [LP] vs. laminectomy [LE]). LE is one of the most common procedures for PSCTs. Despite advantages of LP, it is not yet widely used in the neurosurgical community worldwide. The efficacy of LP vs. LE remains controversial. Adult patients over 18 years of age with PSCT at the level of the cervical, thoracic, and lumbar spine were included in the study. A literature search was performed in MEDLINE via PubMed, EMBASE, The Cochrane Library, and Google Scholar up to December 2021. Operation time, hospital stay, complications, and incidence of postoperative spinal deformity (kyphosis or scoliosis were extracted. A total of seven retrospective observational studies with 540 patients were included. There were no significant differences between LP and LE group in operation time (p=0.25) and complications (p=0.48). The LE group showed larger postoperative spinal deformity rate than the LP group (odds ratio, 0.47; 95% confidence interval [CI], 0.27−0.84; p=0.01). The LP group had a shorter hospital stay (standardized mean differences, −0.68; 95% CI, −1.03 to −0.34; p=0.0001) than the LE group. Both LP and LE have comparable operative times and total complications in the treatment of PSCT. LP was superior to LE in hospital stay and postoperative spinal deformity rate. However, these findings are limited by the very low quality of the available evidence. Randomized controlled trials are needed for further comparison.

Does Posterior Cord Compression from the Ligamentum Flavum Influence Clinical Outcomes Following Anterior Cervical Discectomy and Fusion?

“…Laminoplasty, posterior laminectomy and fusion, or ACDF combined with posterior decompression might result in better outcomes in these clinical scenarios. 1,12,15,30,31 However, although the present study demonstrated poor clinical outcomes for ACDF in the setting of severe CCLF, it could not prove the superiority of the posterior or combined approach over ACDF for cervical myelopathy aggravated by CCLF. Further studies should focus on this comparison in the future.…”

“…As ACDF for CCLF is associated with poor clinical results, performing posterior surgery or using a combined approach could be considered when grade 2 posterior cord compression by ligamentum flavum is identified on preoperative MRI imaging. Laminoplasty, posterior laminectomy and fusion, or ACDF combined with posterior decompression might result in better outcomes in these clinical scenarios 1,12,15,30,31 . However, although the present study demonstrated poor clinical outcomes for ACDF in the setting of severe CCLF, it could not prove the superiority of the posterior or combined approach over ACDF for cervical myelopathy aggravated by CCLF.…”

Spinal Intradural Tumor Resection via Long-Segment Approaches and Clinical Long-Term Follow-Up

“…Factors potentially leading to instability after laminoplasties are preoperative deformities and performing facetectomies. None of these criteria were present in our cohort [19][20][21].…”

Intradural cystic schwannomas of the spine: A case-based systematic review of an unusual tumor

“…The vast majority of patients underwent laminectomy rather than laminoplasty, however, the rationale for this decision was generally not provided. Especially in junctional regions of the spine and in multi-level approaches, we prefer restoring the anatomy by laminoplasty - an approach that appears to be supported by recent literature ( Sun et al, 2019 ; Byvaltsev et al, 2023 ). In one of our cases, we also chose laminoplasty over laminectomy in order to reduce the risk of post-laminectomy kyphosis and to potentially facilitate the approach in case of a potential future revision surgery.…”