Volumetric analysis of bilateral spinal canal decompression via hemilaminectomy versus laminoplasty in cervical spondylotic myelopathy

Silvia Hernández-Durán,Noman Zafar,Daniel Behme,Veit Rohde,Ingo Fiss,Dorothee Mielke,Matthias Momber

doi:10.1007/s00701-020-04453-z

Silvia Hernández-Durán, Noman Zafar + Show 5 more

Open Access

https://doi.org/10.1007/s00701-020-04453-z

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Abstract

BackgroundCervical spondylotic myelopathy (CSM) is a degenerative process of the cervical spine requiring surgical decompression to prevent neurological deterioration. While both anterior and posterior approaches yield satisfactory results, posterior decompression is preferred in cases of the multilevel disease. In 2015, we described a muscle-sparing, novel technique of bilateral osteoligamentous decompression via hemilaminectomy (OLD) for CSM. In this study, we investigate whether this technique offers comparable volumetric results to laminoplasty in terms of spinal canal enlargement and whether this technique can yield significant clinical improvement.MethodsPatients undergoing OLD due to CSM were prospectively enrolled in this study and then matched to and compared with a historic cohort of patients with CSM treated by laminoplasty. An independent sample t test was performed to analyze whether the volumetric gain in the two separate groups was statistically significant. Patients in the OLD cohort were clinically evaluated with the mJOA score preoperatively and 3 months postoperatively. To assess clinical improvement, a paired sample t test was performed.ResultsA total of 38 patients were included in the analysis: 19 underwent OLD and 19 underwent laminoplasty. Both groups were well matched in terms of sex, age, preoperative spinal canal volume, and involved levels. Both surgical methods yielded statistically significant volumetric gain in the cervical spinal canal, but a trend towards a greater volume gain was seen in the OLD group. In the OLD group, a statistically significant clinical improvement was also demonstrated.ConclusionsOur study reveals that OLD can yield a comparable extent of decompression to laminoplasty in CSM while also delivering statistically significant clinical improvement.

Highlights

Cervical spondylotic myelopathy (CSM) is a degenerative process in which the cervical spinal cord (SC) becomes compressed due to osteophytes, disc bulging, yellow ligament hypertrophy, and facet joint arthrosis
While both anterior and posterior approaches yield satisfactory results, posterior decompression is preferred in cases of multilevel disease due to lower complication rates and extensive volume gain [12, 19]
One of the senior authors (D.M.) first described a musclesparing, novel technique of bilateral osteoligamentous decompression via hemilaminectomy (OLD) for CSM in 2015 [13]. We investigate whether this technique offers comparable volumetric results to LP in terms of spinal canal enlargement

Summary

Introduction

Cervical spondylotic myelopathy (CSM) is a degenerative process in which the cervical spinal cord (SC) becomes compressed due to osteophytes, disc bulging, yellow ligament hypertrophy, and facet joint arthrosis. Evidence suggests that 20% to 60% of patients will experience neurological deterioration without surgical intervention [8] While both anterior and posterior approaches yield satisfactory results, posterior decompression is preferred in cases of multilevel disease due to lower complication rates and extensive volume gain [12, 19]. Cervical spondylotic myelopathy (CSM) is a degenerative process of the cervical spine requiring surgical decompression to prevent neurological deterioration. While both anterior and posterior approaches yield satisfactory results, posterior decompression is preferred in cases of the multilevel disease. We investigate whether this technique offers comparable volumetric results to laminoplasty in terms of spinal canal enlargement and whether this technique can yield significant clinical improvement

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