A Comparison of Anterior Cervical Fusion, Cervical Laminectomy, and Cervical Laminoplasty for the Surgical Management of Multiple Level Spondylotic Radiculopathy
The risks and success of surgery for multiple level cervical spondylotic radiculopathy differs from that of single level disease. The problems associated with multiple level anterior fusion over single level fusion include higher pseudoarthrosis rates than that associated with single level disease. Bilateral and multiple level laminectomy carries the risk of potential instability. Cervical laminoplasty, until recently, has only been peformed for myelopathy secondary to ossification of the posterior longitudinal ligament (OPLL) or cervical stenosis. The purpose of this report is to compare the results and complications of 45 patients with a least a 2-year follow-up who had undergone anterior fusion, cervical laminectomy, or cervical laminoplasty for the surgical management of multiple level cervical radiculopathy due to cervical spondylosis. 18 patients (58 levels) underwent anterior fusion, 12 patients (38 levels) had a cervical laminectomy, and 15 patients (57 levels) underwent a cervical laminoplasty. Roentgenograms indicated spinal stenosis (sagittal diameter less than 12 mm) at 28 levels (15 patients) for the anterior fusion group, 14 levels (9 patients) in the laminectomy group, and 24 levels (13 patients) in the laminoplasty group. Subluxation (2 mm or less) was present at 14 levels (13 patients) in the anterior fusion group, nine levels (9 patients) in the laminectomy group, and 15 levels (8 patients) in the laminoplasty group. Loss of lordosis was present in eight patients undergoing anterior fusion, six patients undergoing laminectomy, and six patients who had a laminoplasty. The success rate was 92% (excellent-4, good-13, poor-1) for anterior fusion, 66% (excellent-2, good-6, poor-4) for cervical laminectomy and 86% (excellent-5, good-8, poor-2) for cervical laminoplasty. When the success rate was evaluated for unilateral vs. bilateral radiculopathy, anterior fusion provided the best results. (9/9 unilateral, 8/9 bilateral) followed by laminoplasty (6/6 unilateral, 7/9 bilateral). Laminectomy gave the poorest result for bilateral radiculopathy 3/5 poor vs. 6/7 good for unilateral radiculopathy. The results permit the following conclusions: 1) Anterior cervical fusion provides the best results for surgical treatment of multi-level cervical radiculopathy secondary to spondylosis. 2) Cervical laminoplasty provides an effective alternative to anterior fusion. 3) Cervical laminectomy provided the least favorable results for the surgical treatment of multi-level spondylosis. 4) Range of motion is most limited by cervical laminoplasty.