Corpectomies versus laminoplasty for multilevel cervical myelopathy: an independent matched cohort analysis

Abstract

Charles C. Edwards, II, MD, Atlanta, GA, USA; John Heller, MD, Hidecki Morikami, Decatur, GA, USAIntroduction: The treatment of choice for multilevel cervical myelopathy remains a matter of investigation. For the decompression of three or more motion segments, multilevel corpectomies and laminoplasty have proven effective while avoiding the pitfalls of laminectomy. Direct clinical comparisons of these two procedures are few in number and limited by the heterogeneity in their patient groups. The purpose of this study is to compare the clinical and radiographic outcomes of corpectomy and laminoplasty using an independent matched-cohort analysis.Methods: Medical records of all patients treated for multilevel cervical myelopathy with either corpectomy or laminoplasty between 1992 and 1999 at our institution were reviewed. Thirty-four corpectomy and 51 laminoplasty patients fulfilled stringent inclusion and exclusion criteria. From this pool of eligible patients, 13 patients who underwent corpectomy were blindly matched with 13 patients that underwent laminoplasty based on known prognostic criteria. A single physician independently evaluated each patient and their radiographs at their latest follow-up appointment.Results: The cohorts were well matched by age, duration of symptoms, severity of myelopathy (Nurick grade), canal stenosis and preoperative sagittal alignment (C2–C7). The mean operative time, blood loss and hospital stay were nearly identical. The mean follow-up for corpectomy and laminoplasty were 3.7 and 3.0 years, respectively. Laminoplasty patients showed greater neurologic improvement (Nurick score 1.5 versus 1.0). Subjective improvements in strength, dexterity, sensation, pain and gait were similar for the two operations. The prevalence of axial discomfort at latest follow-up was the same for each cohort, but the analgesic requirements were greater for patients who underwent corpectomy. Sagittal motion from C2 to C7 decreased by 57% after corpectomy and by 46% after laminoplasty. One complication (transient C5 palsy) occurred in the laminoplasty group. Corpectomy complications included progression of myelopathy (one), persistent dysphagia (four), persistent dysphonia (two), significant subjacent disc degeneration (two) and nonunion (one).Conclusion: Corpectomy and laminoplasty reliably arrest myelopathic progression in multilevel cervical myelopathy and can lead to significant neurologic recovery and pain reduction in a majority of patients. The laminoplasty cohort required less pain medication at final follow-up than did the corpectomy patients. Given this and the higher prevalence of complications among corpectomy patients, we believe that laminoplasty may be the preferred treatment for multilevel cervical myelopathy in the absence of preoperative kyphosis.