Outcomes After Laminoplasty Compared With Laminectomy and Fusion in Patients With Cervical Myelopathy

Yoon, S. Tim; Hashimoto, Robin; Raich, Annie; Shaffrey, Christopher I.; Rhee, John M.; Riew, K. Daniel

doi:10.1097/brs.0b013e3182a7eb7c

Cited by 101 publications

(70 citation statements)

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“…In patients with multilevel CSM, neck pain is typically an indication to offer LPSF because previous studies have demonstrated a high incidence of new neck pain following laminoplasty, as high as 25% of patients. 7,27 However, according to the findings from this study among patients with matched postoperative cervical alignment and lordosis, follow-up pain incidence and severity were similar for patients who underwent laminoplasty or LPSF, despite the presence or absence of preoperative neck pain. This may suggest that postoperative cervical alignment and curve is a significant determinant in influencing the efficacy of either laminoplasty or LPSF in treating neck pain.…”

Section: 27mentioning

confidence: 85%

“…4,24 Furthermore, pseudarthrosis becomes a concern with LPSF over time, and reported rates are as high as 38%. 27 However, the actual difference in perioperative morbidity and complications between multilevel laminoplasty and LPSF is relatively small and patients tolerate both procedures well. In fact, it has been suggested that when addressing more than 4 levels, postoperative pain following laminoplasty is greater than that in LPSF.…”

Section: Discussionmentioning

confidence: 99%

“…6,19 Several studies have demonstrated that laminoplasty offers neurological improvement (modified Japanese Orthopaedic Association [JOA], Odom, and Nurick scales) similar to that of LPSF in the treatment of multilevel CSM. 5,25,27 The decision as to which surgical procedure to perform is not always transparent and often depends on a multitude of patient-and clinically related factors, such as age, medical morbidity (risk for surgery), neck pain, cervical lordosis, axial movement with neck flexion-extension, and social factors. Traditionally, LPSF is offered to patients with concomitant neck pain in addition to CSM.…”

Section: Discussionmentioning

confidence: 99%

“…The decision to use either procedure is based on each individual case and surgeon familiarity. 5,13,27 Over the past 5-10 years, there has been a greater understanding of the relation of regional and global spinal alignment with functional and pain outcomes. In particular, cervical alignment has been suggested as an important factor associated with neck pain.…”

mentioning

confidence: 99%

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

Lau

Winkler

Than

et al. 2017

Journal of Neurosurgery: Spine

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OBJECTIVECervical 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.METHODSAdults 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.RESULTSA 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 < 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.CONCLUSIONSFor 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.

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Section: 27mentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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

Lau

Winkler

Than

et al. 2017

Journal of Neurosurgery: Spine

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“…In multilevel anterior cervical fusion, the pseudarthrosis most commonly occurs at the lowest fusion level, and even with BMP-2 augmentation, the rate is approximately 10% [41]. After laminectomy and fusion, the pseudarthrosis rate was found to range from 1% to 38% in a recent systematic review [57]. Flexion and extension radiographs and CT scan can evaluate the fusion site (Fig.…”

Section: Pseudarthrosismentioning

confidence: 99%

Revision Surgery for Failed Cervical Spine Reconstruction

2014

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Background: As the number of cervical spine procedures performed continues to increase, the need for revision surgery is also likely to increase. Surgeons need to understand the etiology of post-surgical changes, as well as have a treatment algorithm when evaluating these complex patients. Questions/Purposes: This study aims to review the rates and etiology of revision cervical spine surgery as well as describe our treatment algorithm. Methods: We used a narrative and literature review. We performed a MEDLINE (PubMed) search for "cervical" and "spine" and "revision" which returned 353 articles from 1993 through January 22, 2014. Abstracts were analyzed for relevance and 32 articles were reviewed. Results: The rates of revision surgery on the cervical spine vary by the type and extent of procedure performed. Patient evaluation should include a detailed history and review of the indication for the index procedure, as well as lab work to rule out infection. Imaging studies including flexion/extension radiographs and computed tomography are obtained to evaluate potential pseudarthrosis. Magnetic resonance imaging is helpful to evaluate the disc, neural elements, soft tissue, and to differentiate scar from infection. Sagittal alignment should be corrected if necessary. Conclusions: Recurrent or new symptoms after cervical spine reconstruction can be effectively treated with revision surgery after identifying the etiology, and completing the appropriate workup.

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