Laminoplasty with Foraminotomy versus Anterior Cervical Discectomy and Fusion for Cervical Myeloradiculopathy

Abstract

Background contextAnterior cervical discectomy and fusion (ACDF) combined with uncinate process resection and laminoplasty combined with foraminotomy (LPF) have been used to achieve cervical cord and root decompression in patients with combined cervical myeloradiculopathy (CMR). PurposeTo compare the clinical and radiographic outcomes of ACDF with those of LPF for the treatment of CMR. Study design/SettingPropensity score-matched retrospective cohort study Patient samplePatients with CMR who underwent ACDF or LPF and were followed up for at least 2 years. Outcome measuresC2–C7 lordosis, C2–C7 sagittal vertical axis, and cervical range of motion (ROM) were determined. The visual analog scale (VAS) scores for neck and arm pain, neck disability index (NDI), and Japanese Orthopedic Association (JOA) scores were analyzed. MethodsThe radiographic and clinical outcomes of the two groups were compared. ResultsEighty-four patients were included (n=42 in each group) after application of the inclusion criteria and propensity score matching. A significant decrease in C2–C7 lordosis (p<0.001) and ROM (p<0.001) was observed in the LPF and ACDF groups, respectively. LPF was associated with a significant decrease in C2–C7 lordosis (p<0.001), while ACDF caused a significant decrease in cervical ROM (p<0.001). ACDF effectively improved neck pain VAS (p<0.001) and NDI (p<0.001), while neck pain did not significantly improve after LPF (p=0.103). Furthermore, neck pain VAS (p=0.026) and NDI (p=0.021) at postoperative 6 months, were significantly greater in the LPF group than in the ACDF group, while the difference was not statistically significant at 2 years postoperatively (neck pain VAS, p=0.502; NDI, p=0.085). Arm pain VAS and JOA score both significantly improved after LPF (p=0.003 and 0.043, respectively) or ACDF (p<0.001 and 0.039, respectively), and postoperative results were not significantly different between the two groups. ConclusionLPF and ACDF yielded similar outcomes for arm pain and neurological recovery. More immediate neck pain improvement was observed with ACDF, while neck pain after 2 years postoperatively was similar between the LPF and ACDF groups. Furthermore, increased postoperative loss of lordosis was observed in the LPF group, whereas decreased postoperative ROM was observed in the ACDF group. These findings should be considered when deciding the surgical method for patients with CMR. Level of evidenceIII