Laminoplasty For Multilevel Cervical Myelopathy Research Articles

A Comparison of Clinical Outcomes Between Anterior Cervical Discectomy and Fusion Versus Posterior Cervical Laminoplasty for Multilevel Cervical Myelopathy.

Retrospective Cohort. To compare patient-reported outcomes and surgical outcomes after anterior cervical discectomy and fusion (ACDF) versus cervical laminoplasty for multilevel cervical spondylotic myelopathy. Treatment options for multilevel cervical spondylotic myelopathy include ACDF and cervical laminoplasty. Given that the literature has been mixed regarding the optimal approach, especially in patients without kyphosis, there is a need for additional studies investigating outcomes between ACDF and cervical laminoplasty. A retrospective review was conducted of adult patients undergoing 3 or 4-level surgery. Patients with preoperative kyphosis based on C2-C7 Cobb angles were excluded. The electronic medical record and institutional databases were reviewed for baseline characteristics, surgical outcomes, and patient-reported outcomes. A total of 101 patients who underwent ACDF and 52 patients who underwent laminoplasty were included in the study. The laminoplasty cohort had a higher overall Charlson Comorbidity Index (3.10 ± 1.43 vs 2.39 ± 1.57, P = 0.011). Both groups had a comparable number of levels decompressed, C2-C7 lordosis, and diagnosis of myelopathy versus myeloradiculopathy. Patients who underwent laminoplasty had a longer length of stay (2.04 ± 1.15 vs 1.48 ± 0.70, P = 0.003) but readmission, complication, and revision rates were similar. Both groups had similar improvement in myelopathy scores (∆modified Japanese Orthopedic Association: 1.11 ± 3.09 vs 1.06 ± 3.37, P = 0.639). ACDF had greater improvement in Neck Disability Index (∆Neck Disability Index: -11.66 ± 19.2 vs -1.13 ± 11.2, P < 0.001), neck pain (∆Visual Analog Scale-neck: -2.69 ± 2.78 vs -0.83 ± 2.55, P = 0.003), and arm pain (∆Visual Analog Scale-arm: -2.47 ± 3.15 vs -0.48 ± 3.19, P = 0.010). These findings persisted in multivariate analysis except for Neck Disability Index. ACDF and cervical laminoplasty appear equally efficacious at halting myelopathic progression. However, patients who underwent ACDF had greater improvements in arm pain at 1 year postoperatively. Longitudinal studies evaluating the efficacy of laminoplasty to mitigate adjacent segment disease are indicated to establish a robust risk-benefit assessment for these 2 procedures. III.

Is laminectomy and fusion the better choice than laminoplasty for multilevel cervical myelopathy with signal changes on magnetic resonance imaging? A comparison of two posterior surgeries

BackgroundThis study aimed to compare the clinical outcomes and complications between laminectomy and fusion (LF) and laminoplasty (LP) for multi-level cervical spondylotic myelopathy (MCSM) with increased signal intensity (ISI) on T2-weighted images (T2WI).MethodsIn this retrospective cohort study, we analyzed 52 patients with MCSM with ISI on T2WI who underwent laminoplasty (LP group). The Japanese Orthopedic Association (JOA) score, the Visual Analogue Scale (VAS) score, the physical and mental component scores (PCS and MCS) of Short-Form 36 (SF-36), and the extension and flexion ranges of motion (ROMs) were recorded. As controls, propensity score matching identified 52 patients who underwent laminectomy and fusion (LF group) from January 2014 to June 2016 using 7 independent variables (preoperation): age, sex, JOA score, SF-36 PCS, SF-36 MCS, preoperative symptom duration and high signal intensity ratio (HSIR).ResultsThe operative duration in the LF group was significantly higher than that in the LP group. At the last follow-up, the JOA score, VAS score, and SF-36 (PCS and MCS) scores were all significantly improved in both groups. The extension and flexion ROMs were decreased in both groups but significantly better in the LP group than in the LF group. Both groups demonstrated similar clinical improvements at the final follow-up. The complication rate was higher in the LF group.ConclusionThe present study demonstrates that LP for MCSM with ISI on T2WI achieves similar clinical improvement as LF. However, longer operative durations, higher complication rates and lower extension and flexion ROMs were found in the LF group.

Comparing clinical outcomes of using 3 versus 5 titanium miniplates in laminoplasty for multilevel cervical myelopathy: A prospective cohort study

Study designProspective cohort study. ObjectiveThe aim of this study was to compare clinical outcomes, radiographic changes, and complications of cervical expansive open-door laminoplasty（EOLP）for cervical multilevel myelopathy, using either 3 or 5 titanium miniplates. Summary of background dataCervical EOLP is a common and effective operation for cervical myelopathy. Standard procedures utilise either 3 or 5 titanium miniplates; however, no definite conclusion has been given yet on the relationship between clinical outcomes and the quantity of titanium miniplates. MethodWe performed a prospective study of 92 patients who underwent EOLP with either 3 (n ​= ​34) or 5 (n ​= ​58) titanium miniplates at our institution from March 2012 to June 2016. Clinical and radiologic outcomes and complications were compared. ResultCompared with the 5 titanium miniplates group, the 3 titanium miniplates group had shorter operation times and less blood loss (P ​< ​0.05) and needed fewer costs (P ​< ​0.01) during index hospitalisation. The preoperative cervical curvature angle decreased in both groups and revealed no significant differences. There was no significant difference between the two groups in the Japanese Orthopedic Association (JOA) score, JOA recovery rate, loss of range of motion (ROM), anteroposterior diameter (APD), or spinal canal complications (P ​> ​0.05). ConclusionCervical EOLP using 3 titanium miniplates is associated with shorter operation times, less blood loss, and lower operation costs compared with using 5 titanium miniplates. The translational potential of this articleExpansive open-door laminoplasty (EOLP) is an effective procedure for treating multilevel cervical spondylotic myelopathy. The present study indicated that 3 titanium miniplates could achieve similar clinical outcomes but with shorter operation times, less blood loss and operation costs compared with 5 titanium miniplates. These findings may provide some references for clinical applications.

Comparative Effectiveness and Functional Outcome of Open-Door versus French-Door Laminoplasty for Multilevel Cervical Myelopathy: A Meta-Analysis.

BACKGROUND:At present, few reports are comparing these 2 major cervical posterior laminoplasty methods with Open-door and French-door Laminoplasty in terms of neurological recovery, cervical alignment, and surgical complications. Moreover, most of the research has not been well designed.AIM:This study aims to determine comparative effectiveness and functional outcome of open-door versus french-door laminoplasty for multilevel cervical myelopathy.METHODS:The Meta-analysis is used in this study. The study sample is a published research articles on comparative effectiveness and functional outcome of open-door versus french-door laminoplasty for multilevel cervical myelopathy on the internet through databases on PubMed and ProQuest and published between 1997 until December 2018. Weighted mean difference and pooled weighted mean difference are calculated by using the fixed-effect model or random-effect model. Data is processed by using Review Manager 5.3 (RevMan 5.3).RESULTS:This study reviews 58 articles. There are 6 studies conducted a systematic review and continued with Meta-analysis of relevant data. The results showed significant higher postoperative Japanese Orthopaedic Association (JOA) score in open-door laminoplasty (ODL) than French-door laminoplasty (FDL) (weighted mean difference [WMD] = 0.71; 95% confidence interval [CI]: 0.35 to 1.07; p < 0.05). The outcome of procedures treatment of multilevel cervical myelopathy revealed the operative time, cervical range of motion, axial canal diameter postoperative, axial pain reduction and complications events in ODL and FDL there was no significant difference. But for a cervical lordotic angle in ODL and FDL, there was a significant difference; the ODL group were significantly lesser than the FDL group. The recovery rate in ODL and FDL, there was a significant difference; the ODL was shown to be significantly higher than FDL (p < 0.05).CONCLUSION:This analysis suggests that neither cervical laminoplasty approach is superior, based on the postoperative radiological data and complication rate. But the open-door laminoplasty resulted in a higher functional outcome and recovery rate as compared to the French-door laminoplasty.

Laminectomy and fusion vs laminoplasty for multi-level cervical myelopathy: a systematic review and meta-analysis.

Surgical approaches for multi-level cervical spondylotic myelopathy (CSM) include posterior cervical surgery via laminectomy and fusion (LF) or expansive laminoplasty (EL). The relative benefits and risks of either approach in terms of clinical outcomes and complications are not well established. A systematic review and meta-analysis was conducted to address this topic. Electronic searches were performed using six databases from their inception to January 2016, identifying all relevant randomized controlled trials (RCTs) and non-RCTs comparing LF vs EL for multi-level cervical myelopathy. Data was extracted and analyzed according to predefined endpoints. From 10 included studies, there were 335 patients who underwent LF compared to 320 patients who underwent EL. There was no significant difference found postoperatively between LF and EL groups in terms of postoperative JOA (P=0.39), VAS neck pain (P=0.93), postoperative CCI (P=0.32) and Nurich grade (P=0.42). The total complication rate was higher for LF compared to EL (26.4 vs 15.4%, RR 1.77, 95% CI 1.10, 2.85, I 2=34%, P=0.02). Reoperation rate was found to be similar between LF and EL groups (P=0.52). A significantly higher pooled rate of nerve palsies was found in the LF group compared to EL (9.9 vs 3.7%, RR 2.76, P=0.03). No significant difference was found in terms of operative time and intraoperative blood loss. From the available low-quality evidence, LF and EL approaches for CSM demonstrates similar clinical improvement and loss of lordosis. However, a higher complication rate was found in LF group, including significantly higher nerve palsy complications. This requires further validation and investigation in larger sample-size prospective and randomized studies.

Cervical Laminoplasty for Multilevel Cervical Myelopathy

Cervical spondylotic myelopathy can result from degenerative cervical spondylosis, herniated disk material, osteophytes, redundant ligamentum flavum, or ossification of the posterior longitudinal ligament. Surgical intervention for multi-level myelopathy aims to decompress the spinal cord and maintain stability of the cervical spine. Laminoplasty was major surgical advancement as laminectomy resulted in kyphosis and unsatisfactory outcomes. Hirabayashi popularised the expansive open door laminoplasty which was later modified several surgeons. Laminoplasty has changed the way surgeons approach multilevel cervical spondylotic myelopathy.

Corpectomies versus laminoplasty for multilevel cervical myelopathy: an independent matched cohort analysis

Charles C. Edwards, II, MD, Atlanta, GA, USA; John Heller, MD, Hidecki Morikami, Decatur, GA, USAIntroduction: The treatment of choice for multilevel cervical myelopathy remains a matter of investigation. For the decompression of three or more motion segments, multilevel corpectomies and laminoplasty have proven effective while avoiding the pitfalls of laminectomy. Direct clinical comparisons of these two procedures are few in number and limited by the heterogeneity in their patient groups. The purpose of this study is to compare the clinical and radiographic outcomes of corpectomy and laminoplasty using an independent matched-cohort analysis.Methods: Medical records of all patients treated for multilevel cervical myelopathy with either corpectomy or laminoplasty between 1992 and 1999 at our institution were reviewed. Thirty-four corpectomy and 51 laminoplasty patients fulfilled stringent inclusion and exclusion criteria. From this pool of eligible patients, 13 patients who underwent corpectomy were blindly matched with 13 patients that underwent laminoplasty based on known prognostic criteria. A single physician independently evaluated each patient and their radiographs at their latest follow-up appointment.Results: The cohorts were well matched by age, duration of symptoms, severity of myelopathy (Nurick grade), canal stenosis and preoperative sagittal alignment (C2–C7). The mean operative time, blood loss and hospital stay were nearly identical. The mean follow-up for corpectomy and laminoplasty were 3.7 and 3.0 years, respectively. Laminoplasty patients showed greater neurologic improvement (Nurick score 1.5 versus 1.0). Subjective improvements in strength, dexterity, sensation, pain and gait were similar for the two operations. The prevalence of axial discomfort at latest follow-up was the same for each cohort, but the analgesic requirements were greater for patients who underwent corpectomy. Sagittal motion from C2 to C7 decreased by 57% after corpectomy and by 46% after laminoplasty. One complication (transient C5 palsy) occurred in the laminoplasty group. Corpectomy complications included progression of myelopathy (one), persistent dysphagia (four), persistent dysphonia (two), significant subjacent disc degeneration (two) and nonunion (one).Conclusion: Corpectomy and laminoplasty reliably arrest myelopathic progression in multilevel cervical myelopathy and can lead to significant neurologic recovery and pain reduction in a majority of patients. The laminoplasty cohort required less pain medication at final follow-up than did the corpectomy patients. Given this and the higher prevalence of complications among corpectomy patients, we believe that laminoplasty may be the preferred treatment for multilevel cervical myelopathy in the absence of preoperative kyphosis.