Laminoplasty Versus Laminectomy and Fusion in the Surgery Approach for Multilevel Cervical Spondylotic Myelopathy: A Current Perspective and Meta-Analysis

Abstract

Background: Cervical spondylotic myelopathy (CSM) is a clinical disease which characterized by degeneration of the intervertebral discs and nearby spinal structures. The goal of this study is to compare laminoplasty (LP) versus laminectomy and fusion (LF) for multilevel cervical spondylotic myelopathy (CSM) in terms of clinical safety and effectiveness. Methods: This study is a meta-analysis from randomized and non-randomized control study. The database being used were PubMed, Google Scholar, Cochrane Registry, and Embase. The authors extensively searched the relevant papers comparing the clinical efficacy and safety of LF and LP for the therapy of multilayer CSM. The outcome measures recorded were visual analog scale (VAS), cervical curvature index (CCI), The Japanese Orthopaedic Association (JOA) scores, Nurich grade, reoperation rate, complications, and rate of nerve palsies. The analysis were performed by using RevMan 5.3. Results: Our meta-analysis includes a total of 14 papers. The pooled mean difference between LF and LP was insignificant in terms of VAS of neck pain (p=0.54), post-operative CCI (p=0.24), JOA score (p=0.29), Nurich grade (p=0.16) and reoperation rate (p=0.21). The complication and nerve palsies rate was higher in LF group compared to LP group (OR 2.60, 95% CI 1.85, 3.64, I2=26%, P < .00001) and (OR 3.18, 95% CI 1.66, 6.11, I2=47%, P=.0005) respectively. Conclusion: Our meta-analysis demonstrates that the majority of clinical outcomes for surgical treatments of multilevel CSM utilizing LF and LP are comparable. However, it was discovered that LP was superior compared to LF in terms of nerve palsy rate. This needs additional validation and research in more extensive sample-size and randomized studies.