Laminoplasty versus laminectomy with posterior spinal fusion for multilevel cervical spondylotic myelopathy: influence of cervical alignment on outcomes

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Cervical curvature is an important factor when deciding between laminoplasty and laminectomy with posterior spinal fusion (LPSF) for cervical spondylotic myelopathy (CSM). This study compares outcomes following laminoplasty and LPSF in patients with matched postoperative cervical lordosis.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>Adults undergoing laminoplasty or LPSF for cervical CSM from 2011 to 2014 were identified. Matched cohorts were obtained by excluding LPSF patients with postoperative cervical Cobb angles outside the range of laminoplasty patients. Clinical outcomes and radiographic results were compared. A subgroup analysis of patients with and without preoperative pain was performed, and the effects of cervical curvature on pain outcomes were examined.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>A total of 145 patients were included: 101 who underwent laminoplasty and 44 who underwent LPSF. Preoperative Nurick scale score, pain incidence, and visual analog scale (VAS) neck pain scores were similar between the two groups. Patients who underwent LPSF had significantly less preoperative cervical lordosis (5.8° vs 10.9°, p = 0.018). Preoperative and postoperative C2–7 sagittal vertical axis (SVA) and T-1 slope were similar between the two groups. Laminoplasty cases were associated with less blood loss (196.6 vs 325.0 ml, p &lt; 0.001) and trended toward shorter hospital stays (3.5 vs 4.3 days, p = 0.054). The perioperative complication rate was 8.3%; there was no significant difference between the groups. LPSF was associated with a higher long-term complication rate (11.6% vs 2.2%, p = 0.036), with pseudarthrosis accounting for 3 of 5 complications in the LPSF group. Follow-up cervical Cobb angle was similar between the groups (8.8° vs 7.1°, p = 0.454). At final follow-up, LPSF had a significantly lower mean Nurick score (0.9 vs 1.4, p = 0.014). Among patients with preoperative neck pain, pain incidence (36.4% vs 31.3%, p = 0.629) and VAS neck pain (2.1 vs 1.8, p = 0.731) were similar between the groups. Similarly, in patients without preoperative pain, there was no significant difference in pain incidence (19.4% vs 18.2%, p = 0.926) and VAS neck pain (1.0 vs 1.1, p = 0.908). For laminoplasty, there was a significant trend for lower pain incidence (p = 0.010) and VAS neck pain (p = 0.004) with greater cervical lordosis, especially when greater than 20° (p = 0.011 and p = 0.018). Mean follow-up was 17.3 months.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>For patients with CSM, LPSF was associated with slightly greater blood loss and a higher long-term complication rate, but offered greater neurological improvement than laminoplasty. In cohorts of matched follow-up cervical sagittal alignment, pain outcomes were similar between laminoplasty and LPSF patients. However, among laminoplasty patients, greater cervical lordosis was associated with better pain outcomes, especially for lordosis greater than 20°. Cervical curvature (lordosis) should be considered as an important factor in pain outcomes following posterior decompression for multilevel CSM.</jats:p></jats:sec>

Postoperative Non-Pathological Fever Following Posterior Cervical Fusion Surgery : Is Laminoplasty a Better Preventive Method than Laminectomy?

“…The origin of fever was always discussed with the patient's medical specialist to exclude infectious causes, thereby excluding patients with drug-related or post-transfusion fever. Surgical site drains were left in all the patients and were Time 00:00 01:00 02:00 03:00 04:00 05:00 06:00 07:00 08:00 09:00 10:00 11:00 12:00 13:00 14:00 15 removed only when the amount of drained fluid was <100 mL per day, or <30 mL every 8 hours.…”

Recent advances in the management of cervical spondylotic myelopathy: bibliometric analysis and surgical perspectives

“…There were numerous publications that addressed various technical modifications, improved outcomes, and consequences of posterior cervical laminoplasty. 22,27,37 In a prospective study in which 169 patients with anterior and 95 patients with posterior surgery were compared, there were no differences in significant clinical improvements and adverse effects. 20 However, in that particular study for multilevel CSM, the anterior approaches were associated with higher rates of complications and reoperations than the posterior approaches.…”

“…Advances in diagnostic technology, including various imaging modalities, combined with surgical intervention, including decompression and stabilization, could improve the patients' neurological functions, related disability, clinical outcomes, and quality of life. 21,36,37,41,45 The ideal surgical strategies should be tailored by the characteristics and location of cord compression. 38 The main purpose of surgery is usually to decompress the spinal cord while stabilizing the affected segments, and sometimes to prevent or cease progression of kyphotic deformity in the future.…”

Comparative Analysis of the Results of Laminoplasty and Laminectomy With Fixation of the Lateral Masses in the Treatment of Patients With Multilevel Degenerative Diseases of the Cervical Spine

“…Традиционно используется 2 вида задних декомпрессивно-стабилизирующих хирургических способов: ламинотомия с ЛП и ЛФ за боковые массы [10]. Во многом выбор в пользу таких операций основывается на виде компрессии спинного мозга (передней или задней), дооперационных параметрах сагиттального профиля шейного отдела позвоночника, распространенности патологического процесса и объеме сегментарных движений [11; 12].…”