Effectiveness of laminectomy with fusion and laminectomy alone in degenerative cervical myelopathy

Abstract

Purpose The effectiveness of laminectomy with fusion and laminectomy alone in degenerative cervical myelopathy was compared. Methods Individuals treated with laminectomy with fusion or laminectomy alone at or below the second cervical vertebra were identified in the Swedish spine registry. 66 individuals treated with laminectomy and instrumented fusion were age matched to 132 individuals treated with laminectomy alone. The European Myelopathy Scale (EMS), the Neck Disability Index (NDI), the Numeric Rating Scale (NRS) for neck pain and the EQ-5D index were available at baseline, and at 1 and 2 year follow-ups. Statistical analyses were performed with Mann–Whitney U tests and paired T tests. Effect sizes were described with Cohen’s D. Results Data at baseline did not differ significantly between the groups with the exception of a longer laminectomy in the fusion group (4.2 vs 3.4 vertebras; p < 0.001). Both groups improved EMS, NDI, NRS and EQ-5D from baseline to 1 year (p ≤ 0.011), with no additional improvement between 1 and 2 years (all p ≥ 0.09). Effect sizes for change from baseline were small to medium in both groups. At 2 years the laminectomy with fusion group and the laminectomy alone group had a median (25th;75th percentile) EMS of 13 (11;13) and 13 (11;15) (p = 0.77), NDI of 39 (24;54) and 27 (10;41) (p = 0.045), NRS of 4 (1;2) and 2 (0;5) (p = 0.048), and EQ-5D index of 0.67 (0.25;0.73) and 0.66 (0.17;0.76) (p = 0.96). Conclusion The results of this study suggest similar effectiveness of laminectomy with instrumented fusion and laminectomy alone in degenerative cervical myelopathy. Level of evidence III.

Patient Reported Data as Predictors of Surgical Outcome in Patients with Degenerative Cervical Myelopathy. Analysis of a National Multicenter Dataset

“…However, the results are consistent with previous, smaller, studies. 2,4,11,20,23,26,27 In conclusion, the results of this study suggest that patient-reported duration of symptoms, preoperative walking distance and disease severity are predictors of outcome in patients treated surgically for degenerative cervical myelopathy. Our findings also suggest that patients with less severe myelopathy and with shorter duration of symptoms are more likely to be satisfied with the surgical treatment, although patients irrespective of degree of disease severity may benefit from surgery.…”

“…Type of surgery was not a predictor of outcome in accordance with recent studies. 26,27 This study has some limitations. First, it is retrospective in nature and therefore prone to selection bias.…”

Surgery for degenerative cervical myelopathy in the elderly: a nationwide registry-based observational study with patient-reported outcomes

“…Both groups experienced statistically significant improvement in all outcome measures. The clinical improvement is, however, modest, and the study population as a whole did not meet the recently suggested MCIC for NDI, NRS pain scores, and EQ-5D in a study from the Swedish Spine Registry [29]. One could argue that MCIC is of lesser importance given the often progressive nature of DCM [7].…”

Unilateral Biportal Endoscopic Laminectomy for Treating Cervical Stenosis: A Technical Note and Preliminary Results

“…There have been no long-term follow-up studies on the clinical and radiologic results of UBEL in the treatment of CS, particularly the development of sagittal imbalance. In a two-year follow-up study, conventional laminectomy with instrumented fusion and laminectomy alone in degenerative cervical myelopathy (DCM) revealed similar effectiveness [ 18 ]. Dios compared patient-reported 5-year clinical results between conventional laminectomy alone and laminectomy with instrumented fusion in patients with DCM and found no important differences [ 19 ].…”