The Safety and Efficacy of Cervical Laminectomy and Fusion versus Cervical Laminoplasty Surgery in Degenerative Cervical Myelopathy: A Prospective Randomized Trial
DOI:
https://doi.org/10.3889/oamjms.2020.4841Keywords:
Cervical spondylotic myelopathy, cervical laminectomy and lateral mass fusion., cervical laminoplasty, Degenerative cervical myelopathyAbstract
BACKGROUND: There is a lack of evidence of whether degenerative cervical myelopathy (DCM) is best treated through cervical laminoplasty (CLP) or cervical laminectomy with lateral mass fusion due to the lack of prospective randomized studies that are well designed. We conducted the largest prospective randomized trial to date to determine the comparative effectiveness and safety of both approaches.
METHODS: In this prospective, randomized trial, we randomly assigned patients who had symptoms or signs of DCM to undergo either cervical laminectomy and lateral mass fixation (CLF) or CLP. The primary outcome measures were the change in the Visual Analog Scale (VAS), neck disability index, modified Japanese Orthopedic Association (mJOA) score, and Nurick’s myelopathy grading 1 year after surgery. The secondary outcome measures were the intraoperative, post-operative complications, hospital stay, C2-7 Cobb’s angle, and Odom’s criteria. The follow-up period was at least 1 year.
RESULTS: A total of 30 patients (mean age, 54.5 ± 5.5 years, 70% of men) underwent prospective randomization. There was a significantly greater improvement in neck pain (VAS) in the CLF group at 1 year (p < 0.05). The improvement in the mJOA and Nurick’s myelopathy grading showed insignificant improvement between both groups. Furthermore, there was no significant difference in the patient’s post-operative satisfaction (Odom’s criteria). The mean operative time was significantly longer in the CLF group (p < 0.001), with no significant difference in the post-operative complications, however, there was a higher rate of C5 palsy, dural tear and infection in the CLF, and a higher rate of instrumentation failure in the CLP. The mean hospital stay was significantly longer in the posterior group (p < 0.05). Finally, there was a significant better improvement in the C2-7 Cobb’s angle at 1 year in the CLF group (p < 0.05).
CONCLUSION: Among patients with multilevel DCM, the CLF approach was significantly better regarding the post-operative pain and Cobb’s angle while the CLP was significantly better in terms of shorter hospital stay and operative time.
Downloads
Metrics
Plum Analytics Artifact Widget Block
References
Hu P, He Z, Cui J, Wan Y. Pathological changes of cervical spinal canal in cervical spondylotic myelopathy: A retrospective study on 39 cases. Clin Neurol Neurosurg. 2019;181:133-7. https://doi.org/10.1016/j.clineuro.2019.04.016 PMid:31039495 DOI: https://doi.org/10.1016/j.clineuro.2019.04.016
El-Ghandour NM, Soliman MA, Ezzat AA, Mohsen A, Zein- Elabedin M. The safety and efficacy of anterior versus posterior decompression surgery in degenerative cervical myelopathy: A prospective randomized trial. J Neurosurg Spine. 2020;32(4):1- 9. https://doi.org/10.3171/2020.2.spine191272 PMid:32357329 DOI: https://doi.org/10.3171/2020.2.SPINE191272
Kalsi-Ryan S, Singh A, Massicotte EM, Arnold PM, Brodke DS, Norvell DC, et al. Ancillary outcome measures for assessment of individuals with cervical spondylotic myelopathy. Spine (Phila Pa 1976). 2013;38(1):S111-22. https://doi.org/10.1097/ brs.0b013e3182a7f499 PMid:23963009 DOI: https://doi.org/10.1097/BRS.0b013e3182a7f499
Bakhsheshian J, Mehta VA, Liu JC. Current diagnosis and management of cervical spondylotic myelopathy. Global Spine J. 2017;7(6):572-86. https://doi.org/10.1177/2192568217699208 PMid:28894688 DOI: https://doi.org/10.1177/2192568217699208
Baron E, Young W. Cervical spondylotic myelopathy: A brief review of its pathophysiology, clinical course, and diagnosis. Neurosurgery. 2007;60(1):S35-41. PMid:17204884 DOI: https://doi.org/10.1227/01.NEU.0000215383.64386.82
Sah S, Wang L, Dahal M, Acharya P, Dwivedi R. Surgical management of cervical spondylotic myelopathy. JNMA J Nepal Med Assoc. 2012;52(188):172-7. https://doi.org/10.31729/ jnma.374 PMid:23591248 DOI: https://doi.org/10.31729/jnma.374
Komotar RJ, Mocco J, Kaiser MG. Surgical management of cervical myelopathy: Indications and techniques for laminectomy and fusion. Spine J. 2006;6(6):252-67. https://doi.org/10.1016/j. spinee.2006.04.029 PMid:17097545 DOI: https://doi.org/10.1016/j.spinee.2006.04.029
Heary RF, MacDowall A, Agarwal N. Cervical spondylotic myelopathy: A two decade experience. J Spinal Cord Med. 2018;42(4):1-9. https://doi.org/10.1080/10790268.2018.147 1780 PMid:30048224 DOI: https://doi.org/10.1080/10790268.2018.1471780
Yoon ST, Hashimoto RE, Raich A, Shaffrey CI, Rhee JM, Riew KD. Outcomes after laminoplasty compared with laminectomy and fusion in patients with cervical myelopathy: A systematic review. Spine (Phila Pa 1976). 2013;38(1):S183-94. https://doi.org/10.1097/brs.0b013e3182a7eb7c PMid:23963000 DOI: https://doi.org/10.1097/BRS.0b013e3182a7eb7c
Highsmith JM, Dhall SS, Haid RW, Rodts GE, Mummaneni PV. Treatment of cervical stenotic myelopathy: A cost and outcome comparison of laminoplasty versus laminectomy and lateral mass fusion. J Neurosurg Spine. 2011;14(5):619-25. https://doi. org/10.3171/2011.1.spine10206 PMid:21388285 DOI: https://doi.org/10.3171/2011.1.SPINE10206
Manzano GR, Casella G, Wang MY, Vanni S, Levi AD. A prospective, randomized trial comparing expansile cervical laminoplasty and cervical laminectomy and fusion for multilevel cervical myelopathy. Clin Neurosurg. 2012;70(2):264-76. https:// doi.org/10.1227/neu.0b013e3182305669 PMid:22251974 DOI: https://doi.org/10.1227/NEU.0b013e3182305669
Lau D, Winkler EA, Than KD, Chou D, Mummaneni PV. Laminoplasty versus laminectomy with posterior spinal fusion for multilevel cervical spondylotic myelopathy: Influence of cervical alignment on outcomes. J Neurosurg Spine. 2017;27(5):508-17. https://doi.org/10.3171/2017.4.spine16831 PMid:28862572 DOI: https://doi.org/10.3171/2017.4.SPINE16831
Du W, Wang L, Shen Y, Zhang Y, Ding W, Ren L. Long-term impacts of different posterior operations on curvature, neurological recovery and axial symptoms for multilevel cervical degenerative myelopathy. Eur Spine J. 2013;22(7):1594-602. https://doi.org/10.1007/s00586-013-2741-5 PMid:23508336 DOI: https://doi.org/10.1007/s00586-013-2741-5
Yang L, Gu Y, Shi J, Gao R, Liu Y, Li J, et al. Modified plate-only open-door laminoplasty versus laminectomy and fusion for the treatment of cervical stenotic myelopathy. Orthopedics. 2012;36(1):e79-87. https://doi. org/10.3928/01477447-20121217-23 DOI: https://doi.org/10.3928/01477447-20121217-23
Blizzard DJ, Caputo AM, Sheets CZ, Klement MR, Michael KW, Isaacs RE, et al. Laminoplasty versus laminectomy with fusion for the treatment of spondylotic cervical myelopathy: Short-term follow-up. Eur Spine J. 2017;26(1):85-93. https://doi. org/10.1007/s00586-016-4746-3 PMid:27554354 DOI: https://doi.org/10.1007/s00586-016-4746-3
Fehlings MG, Santaguida C, Tetreault L, Arnold P, Barbagallo G, Defino H, et al. Laminectomy and fusion versus laminoplasty for the treatment of degenerative cervical myelopathy: Results from the AOSpine North America and international prospective multicenter studies. Spine J. 2017;17(1):102-8. https://doi. org/10.1016/j.spinee.2016.08.019 PMid:27597512 DOI: https://doi.org/10.1016/j.spinee.2016.08.019
Woods BI, Hohl J, Lee J, Donaldson W, Kang J. Laminoplasty versus laminectomy and fusion for multilevel cervical spondylotic myelopathy. Clin Orthop Relat Res. 2011;469(3):688-95. https:// doi.org/10.1007/s11999-010-1653-5 PMid:21089002 DOI: https://doi.org/10.1007/s11999-010-1653-5
Downloads
Published
How to Cite
License
Copyright (c) 2020 Mohamed Elmallawany, Haitham Kandel, Mohamed A. R. Soliman, Tarek Ahmed Tareef, Ahmed Atallah, Ahmed Elsaid, Wael Elmahdy (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
http://creativecommons.org/licenses/by-nc/4.0
