Laminectomy versus open-door laminoplasty for cervical spondylotic myelopathy: A clinical outcome analysis
- Departments of Neurosurgery, University, Via Conca, Ancona, Marche, Italy.
- Departments of Neurology, University, Via Conca, Ancona, Marche, Italy.
DOI:10.25259/SNI_85_2020Copyright: © 2020 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Mauro Dobran, Fabrizio Mancini, Riccardo Paracino, Simona Lattanzi, Lucia di Somma, Davide Nasi, Gianluca Bizzocchi, Denis Aiudi, Maurizio Iacoangeli. Laminectomy versus open-door laminoplasty for cervical spondylotic myelopathy: A clinical outcome analysis. 18-Apr-2020;11:73
How to cite this URL: Mauro Dobran, Fabrizio Mancini, Riccardo Paracino, Simona Lattanzi, Lucia di Somma, Davide Nasi, Gianluca Bizzocchi, Denis Aiudi, Maurizio Iacoangeli. Laminectomy versus open-door laminoplasty for cervical spondylotic myelopathy: A clinical outcome analysis. 18-Apr-2020;11:73. Available from: https://surgicalneurologyint.com/?post_type=surgicalint_articles&p=9964
Background: Cervical spondylotic myelopathy (CSM) is one of the most common diseases in the geriatric population. Decompressive laminectomy or laminoplasty is the predominant surgical procedure of choice, but there remains debate as to which procedure is optimal for managing CSM.
Methods: Here, we retrospectively analyzed 64 patients with CSM undergoing laminectomy (39 patients) versus laminoplasty (25 patients). The data were collected included respective Japanese orthopedic association (JOA) scores, Nurick grades, and Visual analog scale (VAS) values preoperatively versus 12 months postoperatively.
Results: The JOA score after 1 month improved in both groups utilizing laminectomy or laminoplasty. However, at 12 postoperative months, the JOA scores and Nurick grades showed greater improvement following laminoplasty, despite no differences in postoperative pain and complication rates.
Conclusion: Patients with cervical spondylotic myelopathy undergoing laminoplasty (25 patients) showed better 12-month postoperative outcomes (JOA scores and Nurick grades) versus those having laminectomies (39 patients).
Keywords: Cervical laminectomy, Cervical myelopathy, Cervical spondylotic myelopathy, Laminoplasty, Open- door technique, Spinal cord decompression
Cervical spondylotic myelopathy (CSM) is the most common cause of nontraumatic spinal cord lesions in adults and geriatric patients.[
We retrospectively reviewed the postoperative outcomes (Japanese orthopedic association [JOA] scores, Nurick grades, and Visual analog scale [VAS] scales) for 64 patients with CSM from 2015 to 2018 and MR/CT-documented cord compression. Patients averaged 74.8 years of age (range 57–87 years old) [
For these patients with CSM, 39 (60.9%) underwent cervical laminectomy without fusion, and 25 (39.1%) had open-door laminoplasty. The mean age of the study cohort was 76.4 and 47 (73.4%) of the patients were male [
Open-door laminoplasty versus laminectomy
Twenty-five patients underwent the classic Hirabayashi open-door laminoplasty.[
Values are presented as mean ± SD or median. Univariate comparisons were made through the Student’s t-test, Wilcoxon rank-sum test, or Chi-squared test. Changes in the scores obtained at 12 months after surgery were estimated using linear regression analysis. Data analysis was performed using STATA/IC 13.1 statistical package (StataCorp LP, Texas, USA).
Twelve-month postoperative scores JOA scores and Nurick grades were significantly improved for the 25 having open- door laminoplasty and 39 undergoing cervical laminectomy without fusion [
Postoperative complications occurred in 10 (15.6%) patients; five wound infections three new neurological deficits, one pulmonary embolism, and one case of pneumonia. There were no significant differences in the rates of other complications in the cervical laminectomy versus open-door laminoplasty groups (e.g., 18.0% versus 12%, respectively, P = 0.523).
Postoperative kyphosis and segmental instability after laminectomy are reported in from 6 to 47% of adults but in 100% of children.[
The literature demonstrates different pros and cons for laminoplasty versus laminectomy. The prospective AOSpine CSM – North America study involving 757 patients with CSM showed no difference in 1-year clinical outcomes between laminectomy with fusion versus laminoplasty (JOA scores of 2.45 and 2.51, respectively).[
The better clinical improvement seen in our series of 25 patients undergoing laminoplasty was based on the JOA score (not the Nurick grades), but there were no significant differences in the rates of pain improvement or complication.[
Our 25 patients with multilevel CSM undergoing laminoplasty showed better 12-month postoperative neurological outcomes based on significant improvement in JOA scores versus the 39 patients undergoing laminectomy without fusion.
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