Neurospine.  2021 Mar;18(1):45-54. 10.14245/ns.2040520.260.

Getting Down to the Bare Bones: Does laminoplasty or laminectomy With Fusion Provide Better Outcomes for Patients With Multilevel Cervical Spondylotic Myelopathy?

Affiliations
  • 1School of Medicine, University of California, Irvine, Irvine, CA, USA
  • 2Keck School of Medicine of USC, Los Angeles, CA, USA
  • 3Medical Scientist Training Program, California Institute of Technology, Pasadena, CA, USA
  • 4Case Western Reserve University School of Medicine, Cleveland, OH, USA
  • 5University of Southern California, Los Angeles, CA, USA
  • 6College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
  • 7Department of Neurological Surgery, Geisinger Health System, Danville, Pennsylvania, PA, USA
  • 8Department of Neurologic Surgery, Mayo Clinic Alix School of Medicine, Rochester, MN, USA
  • 9Department of Neurological Surgery, University of California, San Diego, La Jolla, CA, USA
  • 10Department of Neurological Surgery, University of California, Irvine, Orange, CA, USA

Abstract


Objective
Cervical spondylotic myelopathy (CSM) is a degenerative disorder leading to progressive decline in spinal cord function. Cervical laminoplasty (CLP) and cervical laminectomy with fusion (CLF) are standard treatments for multilevel CSM. However, it is still unclear whether one procedure over the other provides better outcomes. Here, we performed a comprehensive review of published articles that compare the clinical outcomes and costs between CLP and CLF for CSM.
Methods
A literature search was performed using PubMed, Web of Science, and Cochrane databases. Strict exclusion criteria were applied, and included articles were then assessed for publication year, study design, and significant differences in outcome variables.
Results
From 519 studies identified with search terms, 38 studies were included for the qualitative analysis. Statistically significant differences in the clinical outcomes and costs were found in 18 studies. Eleven studies were prospective or retrospective, and 8 studies were meta-analyses. For the outcome variables of interest, results were reported by classifying into prospective studies, retrospective studies, and meta-analyses.
Conclusion
CLP and CLF are 2 of the most commonly performed surgical procedures for the treatment of CSM. Although CLP and CLF each provide satisfactory clinical outcomes for patients with CMS, CLP may result in better cervical range of motion and less cost, length of stay, operation time, blood loss, paraspinal muscular atrophy, and rate of nerve palsies as compared to CLF. The major limitation of CLP versus CLF comparison studies includes the heterogeneity in techniques and preoperative criteria. Thus, further validation and investigations in larger cohorts will be required.

Keyword

Laminectomy; Spinal cord diseases; Laminoplasty; Cervical vertebrae
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