Abstract
BackgroundThere is considerable controversy as to which posterior technique is best for the treatment of multi-level cervical spondylotic myelopathy. The aim of this study was to compare the clinical and radiographic results and complications of laminoplasty (LAMP) and laminectomy (LAMT) in the treatment of multi-level cervical spondylotic myelopathy.MethodsWe reviewed and analyzed papers published from January 1966 and June 2013 regarding the comparison of LAMP and LAMT for multi-level cervical spondylotic myelopathy. Statistical comparisons were made when appropriate.ResultsFifteen studies were included in this systematic review. There was no significant difference in the incidence of surgical complications between LAMP and LAMT. Compared to conventional LAMT and skip LAMT, postoperative ROM was more limited in LAMP, but this was still superior to postoperative ROM following LAMT with fusion. Postoperative kyphosis occurred in 8/180 (4.44%) in LAMP and 13/205 (6.34%) in LAMT, whereas no cases of kyphosis were reported for skip LAMT. Skip LAMT appears to have better clinical outcomes than LAMP, while the outcome was similar between LAMP and LAMT with fusion.ConclusionsBased on these results, a claim of superiority for laminoplasty or laminectomy was not justified. In deciding between the two procedures, the risks of surgical and neurological complications, and radiologic and clinical outcome, must be taken into consideration if both options are available in multi-level cervical spondylotic myelopathy.
Highlights
Cervical spondylotic myelopathy is a progressive disease that often requires surgical intervention [1]
Fifteen studies comparing LAMP and LAMT in treating multi-level cervical spondylotic myelopathy were included in this systematic review [6,7,8,9,10,11,12,13,14,15,16,17,18,19,20]
LAMP surgical procedures mainly refer to opendoor laminoplasty with different fixation, while LAMT surgical procedures were divided into three subgroups as follows: conventional LAMT [6,7,8,11,13,18], skip LAMT [10,12,14], and LAMT with fusion [9,15,16,17,19,20]
Summary
Cervical spondylotic myelopathy is a progressive disease that often requires surgical intervention [1]. Cervical spondylotic myelopathy surgery is often multi-level, which can complicate the surgical management. Even when discussion is limited to posterior procedures, there is considerable controversy as to which technique is best for multi-level posterior cervical decompression. Despite ongoing uncertainty regarding the most effective surgical methods for posterior approach for multi-level cervical spondylotic myelopathy, few systematic reviews have explored this issue. A randomized, controlled trial is necessary to determine the best currently available treatment for multi-level cervical spondylotic myelopathy. There is considerable controversy as to which posterior technique is best for the treatment of multi-level cervical spondylotic myelopathy. The aim of this study was to compare the clinical and radiographic results and complications of laminoplasty (LAMP) and laminectomy (LAMT) in the treatment of multi-level cervical spondylotic myelopathy
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