Laminoplasty Versus Laminectomy and Fusion for Multilevel Cervical Myelopathy
- 1 June 2001
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Spine
- Vol. 26 (12), 1330-1336
- https://doi.org/10.1097/00007632-200106150-00013
Abstract
A matched cohort clinical and radiographic retrospective analysis of laminoplasty and laminectomy with fusion for the treatment of multilevel cervical myelopathy. To compare the clinical and radiographic outcomes of two procedures increasingly used to treat multilevel cervical myelopathy. Traditional methods of treating multilevel cervical myelopathy (laminectomy and corpectomy) are reported to have a notable frequency of complications. Laminoplasty and laminectomy with fusion have been advocated as superior procedures. A comparative study of these two techniques has not been reported. Medical records of all patients treated for multilevel cervical myelopathy with either laminoplasty or laminectomy with fusion between 1994 and 1999 at our institution were reviewed. Thirteen patients that underwent laminectomy with fusion were matched with 13 patients that underwent laminoplasty. All patients and radiographs were independently evaluated at latest follow-up by a single physician. Cohorts were well matched based on patient age, duration of symptoms, and severity of myelopathy (Nurick grade) before surgery. Mean independent follow-up was similar (25.5 and 26.2 months). Both objective improvement in patient function (Nurick score) and the number of patients reporting subjective improvement in strength, dexterity, sensation, pain, and gait tended to be greater in the laminoplasty cohort. Whereas no complications occurred in the laminoplasty cohort, there were 14 complications in 9 patients that underwent laminectomy with fusion patients. Complications included progression of myelopathy, nonunion, instrumentation failure, development of a significant kyphotic alignment, persistent bone graft harvest site pain, subjacent degeneration requiring reoperation, and deep infection. The marked difference in complications and functional improvement between these matched cohorts suggests that laminoplasty may be preferable to laminectomy with fusion as a posterior procedure for multilevel cervical myelopathy.Keywords
This publication has 37 references indexed in Scilit:
- Three- and Four-Level Anterior Cervical Discectomy and Fusion With Plate FixationSpine, 2000
- T-Saw Laminoplasty for the Management of Cervical Spondylotic MyelopathySpine, 2000
- Three-Level Anterior Cervical Discectomy and FusionSpine, 1997
- Lordotic alignment and posterior migration of the spinal cord following en bloc open-door laminoplasty for cervical myelopathy: A magnetic resonance imaging studyZeitschrift für Neurologie, 1996
- Surgical treatment for cervical spondylitic myelopathyJournal of Neurosurgery, 1995
- Postlaminectomy KyphosisOrthopedic Clinics of North America, 1992
- Neurological deterioration after laminectomy for spondylotic cervical myeloradiculopathy: the putative role of spinal cord ischaemia.Journal of Neurology, Neurosurgery & Psychiatry, 1988
- Cervical Spondylosis with Moderate to Severe MyelopathySpine, 1977
- Long-Term Followup of Surgical Treatment of Cervical Spondylotic MyelopathySpine, 1977
- STUDIES IN CERVICAL SPONDYLOTIC MYELOPATHY: I. MOVEMENT OF THE CERVICAL ROOTS, DURA AND CORD, AND THEIR RELATION TO THE COURSE OF THE EXTRATHECAL ROOTSBrain, 1971