Safety and Efficacy of Laminoplasty Versus Laminectomy in the Treatment of Spinal Cord Tumors: A Systematic Review and Meta-Analysis

Abstract

Laminectomy (LAMT) and laminoplasty (LAMP) have been widely applied on patients with spinal cord tumors (SCTs). However, the clinical efficacy of LAMP versus LAMT remains controversial. The purpose of this study is to assess the safety and efficacy of LAMP compared to LAMT in the treatment of SCTs. We searched several English and Chinese databases (PubMed, EMBASE, the Cochrane Library, CBM, CNKI and Wan Fang) to identify relevant randomized controlled trials or observational studies. The quality of included studies was assessed by the Cochrane Collaboration's tool and the Newcastle-Ottawa Scale. The outcome measures included the primary and secondary outcomes. Subgroups analysis was performed to explore the impact of study type, age, type of tumor, tumor size, surgical levels, follow-up time, surgical methods (whether with fusion) on the outcome measures. Sixteen studies of 1096 patients with SCTs were included in this meta-analysis. The results showed statistically significant differences between the LAMP and LAMT groups in terms of effective recovery rate (P= 0.003), blood loss (P < 0.00001), hospital stays (P= 0.006), spinal deformity (P= 0.01), and cerebrospinal fluid leak (P < 0.00001). However, there was no significant differences in total resection rate of tumor (P= 0.21) and operation time (P=0.14). In the subgroup analysis, the results indicated that age, type of tumor, follow-up time, surgical levels, and methods were the influence factors for the incidence of spinal deformity. LAMP might be a safer and more effective surgical method in the treatment of SCTs. In addition, the advantage of fusion in preventing the occurrence of spinal deformity should not to be ignored. However, because of the lack of high quality randomized controlled trials and adequate data, the safety and validity of LAMP was undermined.