Asian Spine J.  2016 Aug;10(4):663-670. 10.4184/asj.2016.10.4.663.

Agreement on the Level Selection in Laminoplasty among Experienced Surgeons: A Survey-Based Study

• Cho JH
• Suk KS
• Park JB
• Ha JK
• Hwang CJ
• Lee CS
• Lee DH

• KMID: 2349288
• DOI: http://doi.org/10.4184/asj.2016.10.4.663

Abstract

STUDY DESIGN: Survey based study. PURPOSE: To assess the degree of agreement in level selection of laminoplasty (LP) for the selected cervical myeloradiculopathy cases between experienced spine surgeons. OVERVIEW OF LITERATURE: Although, cervical LP is a widely used surgical technique for multi-level spinal cord compression, until now there is no consensus about how many segments or which segments should be opened to achieve a satisfactory decompression.
METHODS
Thorough clinical and radiographic data (plain X-ray, computed tomography, and magnetic resonance imaging) of 30 patients who had cervical myelopathy were prepared. The data were provided to three independent spine surgeons with over 10 years experience in operation of their own practices. They were questioned about the most preferable surgical method and suitable decompression levels. The second survey was carried out after 6 months with the same cases. If the level difference between respondents was a half level or below, agreement was considered acceptable. The intraobserver and interobserver agreements in level selection were assessed by kappa statistics.
RESULTS
Three respondents selected LP as an option for 6, 8, and 22 cases in the first survey and 10, 21, and 24 cases in the second survey. The reasons for selection of LP were levels of ossification of the posterior longitudinal ligament (p=0.004), segmental kyphotic deformity (p=0.036) and mean compression score (p=0.041). Intraobserver agreement showed variable results. Interobserver agreement was poor to fair by perfect matching (kappa=0.111-0.304) and fair to moderate by acceptable matching (kappa=0.308-0.625).
CONCLUSIONS
The degree of agreement for level selection of LP was not high even though experienced surgeons would choose the opening segments on the basis of same criteria. These results suggest that more specific guidelines in determination of levels for LP should be required to decrease unnecessary wide decompression according to individual variance.

Keyword

Cervical vertebrae; Spinal cord comression; Laminoplasty; Surveys and questionnaires

MeSH Terms

Cervical Vertebrae
Congenital Abnormalities
Consensus
Decompression
Female
Humans
Laminoplasty*
Longitudinal Ligaments
Methods
Spinal Cord Compression
Spinal Cord Diseases
Spine
Surgeons*
Surveys and Questionnaires