Review of laminoplasty versus laminectomy in the surgical management of cervical spondylotic myelopathy
- Department of Neurosurgery, Università Politecnica delle Marche, Ancona, Marche, Italy.
DOI:10.25259/SNI_788_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: Riccardo Paracino, Maria Rossella Fasinella, Fabrizio Mancini, Alessandra Marini, Mauro Dobran. Review of laminoplasty versus laminectomy in the surgical management of cervical spondylotic myelopathy. 03-Feb-2021;12:44
How to cite this URL: Riccardo Paracino, Maria Rossella Fasinella, Fabrizio Mancini, Alessandra Marini, Mauro Dobran. Review of laminoplasty versus laminectomy in the surgical management of cervical spondylotic myelopathy. 03-Feb-2021;12:44. Available from: https://surgicalneurologyint.com/?post_type=surgicalint_articles&p=10556
Background: We reviewed the literature comparing the indications/efficacy of laminectomy (LA) with or without fusion versus laminoplasty (LP) in the treatment of cervical spondylotic myelopathy (CSM).
Methods: We identified 14 studies in PubMed/Medline to include in our analysis. Outcomes were assessed utilizing the Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS), Neck Disability Index, and Nurick scale. Variables studied included ossification of the posterior longitudinal ligament (OPLL), cervical range of motion (ROM), the C2-C7 sagittal Cobb angle, the Ishihara index, and the Hirabayashi scale. Patients with cervical trauma/fracture, infection, or tumor were excluded from the study.
Results: In these 14 studies, there were no significant differences between LA and LP groups in terms of preoperative versus postoperative: JOA scores (e.g., including the improvement rate), VAS scores, and ROM. However, the LA patients demonstrated greater postoperative cervical lordosis versus those in the LP group.
Conclusion: At present, there are no guidelines for choosing LA versus LP for treating CSM. Factors that should be considered when choosing one procedure over the other should include the patients’ preoperative clinical status, the type of CSM, the pathological extent of OPLL, and whether there is a sufficient cervical lordotic curvature.
Keywords: Cervical laminectomy, Cervical laminoplasty, Cervical spondylotic myelopathy, Open-door laminoplasty
Multilevel cervical spondylotic myelopathy (CSM) is largely attributed to spondyloarthrosis (e.g., including disc disease, spurs, and osteophytes), congenital cervical canal stenosis, and/or ossification of the posterior longitudinal ligament (OPLL). The surgical decompression for CSM may include either laminectomy (LA) with/without fusion versus laminoplasty (LP).[
In the literature, we identified 14 prospective/retrospective studies involving at least 20 adults with CSM undergoing LA versus LP (e.g., including meta-analysis using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses from PubMed [MEDLINE]) [
Comparison of clinical results
There is some disagreement regarding which procedure, the LP versus LA, results in better clinical outcomes. In Heller’s et al. study, there were no statistically significant differences in the Nurick score between LP and LA with fusion groups, although those undergoing LA/fusion had higher complication rates.[
Lee et al. assessed functional improvement using the NDI score following LP versus LA; they found no significant differences for NDI between the two groups (P = 0.84).[
Lee et al. and Yuan et al. documented no significant differences in clinical outcomes and VAS score for LP versus LA.[
Ha et al. study found significantly greater ROM preservation in flexion, extension, and side bending for those undergoing LP versus LA with fusion (P = 0.0006).[
Lau et al. documented that preoperative and postoperative C2–C7 sagittal vertical and cervical Cobb angle were similar between patients undergoing LP versus LA (P = 0.454).[
Relative postoperative lordosis for LP versus LA
Some authors found statistically significant differences regarding the postoperative preservation of cervical lordosis and ROM for LP versus LA.[
Although there are no present guidelines for choosing to treat CSM utilizing either LA versus LP, surgeons should play close attention to patients’ preoperative clinical status, the type of CSM present, (e.g., with/without stenosis/OPLL), and whether the cervical lordotic curvature has been preserved.
All procedures performed underwent IRB Approval (any extra information in tables) with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Patient’s consent not required as patients identity is not disclosed or compromised.
There are no conflicts of interest.
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