236. Laminoplasty vs laminectomy and fusion for multilevel cervical spondylotic myelopathy with increased signal intensity on magnetic resonance imaging

Abstract

BACKGROUND CONTEXT Multilevel cervical spondylotic myelopathy (MCSM) has often a long course of disease, severe cervical spine degeneration, and rapid progress. It is still unclear whether preserving the mobility of the cervical spine will affect the recovery of neurological function in MCSM patients with or without ISI on T2WI. PURPOSE This study aimed to compare the clinical outcomes and complications between laminectomy and fusion (LF) and laminoplasty (LP) for MCSM with increased signal intensity (ISI) on T2-weighted images (T2WI). STUDY DESIGN/SETTING A retrospective study. PATIENT SAMPLE 90 patients. OUTCOME MEASURES The Japanese Orthopedic Association (JOA) score, the Visual Analogue Scale (VAS) score, the physical and mental component scores (PCS and MCS) of the Short-Form 36 (SF36), and the extension and flexion range of motion (ROM) were recorded. The indicators, surgery-related results and complications of the two groups were compared. METHODS We analyzed 45 patients with MCSM with ISI on T2WI who underwent laminoplasty (LP group) from January 2014 to January 2016. The JOA score, VAS score, PCS and MCS of the SF36, and the extension and flexion ROM were recorded. Propensity score matching identified 45 patients underwent laminectomy and fusion (LF Group) as controls, from January 2014 to January 2016 using 7 independent variables (preoperation): age, sex, JOA, duration of preoperative symptoms, the high signal intensity ratio (HSIR), with ossification of the posterior longitudinal ligament and tobacco use. The indicators, surgery-related results and complications of the two groups were compared. RESULTS No statistical difference in the baseline of the two groups. At the final follow-up, both groups demonstrated similar clinical improvement at the final follow-up. The extension and flexion ROM were lost in both groups, but the LP group was significantly better. The complication rate and operative time were found higher in the LF group. CONCLUSIONS The present study demonstrated that laminoplasty for MCSM with ISI on T2WI achieved similar clinical improvement with LF. However, longer operation time, higher complication rate and lower extension and flexion ROM were found in the LF group. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.