Incidence of spinal column deformity after multilevel laminectomy in children and adults

Purpose To compare the clinical outcomes, complications, and surgical trauma between anterior and posterior approaches for the treatment of multilevel cervical spondylotic myelopathy. Study design Systematic review and meta-analysis. Methods We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials databases for randomized controlled trials or non-randomized controlled trials that compared anterior and posterior surgical approaches for the treatment of multilevel cervical spondylotic myelopathy. Exclusion criteria were non-controlled studies, combined anterior and posterior surgery, follow-up \1 year, cervical kyphosis [15°, and cervical myelopathy caused by ossification of the posterior longitudinal ligament. The main end points included: recovery rate; Japanese Orthopedic Association (JOA) score; reoperation rate; complication rate; blood loss; and operation time. Subgroup analysis was conducted according to the mean number of surgical segments. Result A total of eight studies were included in the metaanalysis; none of which were randomized controlled trials. All of the selected studies were of high quality as indicated by the Newcastle-Ottawa scale. In five studies involving 351 patients, the preoperative JOA score was similar between the anterior and posterior groups [P [ 0.05, WMD: -0.00 (-0.56, 0.56)]. In four studies involving 268 patients, the postoperative JOA score was higher in the anterior group compared with the posterior group [P \ 0.05, WMD: 0.79 (0.16, 1.42)]. For recovery rate, there was significant heterogeneity among the four studies involving 304 patients, hence, only descriptive analysis was performed. In seven studies involving 447 patients, the postoperative complication rate was significant higher in the anterior group compared with the posterior group [P \ 0.05, odds ratio: 2.60 (1.63, 4.15)]. Of the 245 patients in the 8 studies who received anterior surgery, 21 (8.57 %) received reoperation. Of the 285 patients who received posterior surgery, only 1 (0.3 %) received reoperation. The reoperation rate was significantly higher in the anterior group compared with the posterior group (P \ 0.001). In the 3 studies involving 236 patients compared subtotal corpectomy and laminoplasty/laminectomy, blood loss and operation time were significantly higher in the anterior subtotal corpectomy group compared with the posterior laminoplasty/laminectomy group [P \ 0.05, WMD: 150.10 (63.53, 236.66) and P \ 0.05, WMD: 59.17 (45.69, 72.66)]. Conclusion The anterior approach was associated with better postoperative neural function than the posterior approach in the treatment of multilevel cervical spondylotic myelopathy. There was no apparent difference in the neural function recovery rate. The complication and reoperation rates were significantly higher in the anterior group compared with the posterior group. The surgical trauma associated with corpectomy was significantly higher than that associated with laminoplasty/laminectomy.

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“…19 Fig. 4 Weight mean difference of recovery rate between anterior surgery group and posterior surgery group.…”

Section: Study or Subgroupmentioning

confidence: 99%

“…Further, some authors have suggested that patients who undergo posterior laminoplasty or laminectomy are more prone to develop cervical kyphosis or instability than those who receive treatment via anterior approaches [19].…”

Section: Introductionmentioning

confidence: 99%

Anterior approach versus posterior approach for the treatment of multilevel cervical spondylotic myelopathy: a systemic review and meta-analysis

et al. 2013

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“…The incidence of chronic pain was 30% and the reported intensity was low (3/10 cm) at GRS for chronic pain. Laminectomy series usually report higher values [15,18,24,34,37]. Laminotomy offers the same exposure of laminectomy while aiming to the preservation of functionally important structures which are left untouched or at least reconstructed.…”

Section: Discussionmentioning

confidence: 99%

Laminotomy in adults: technique and results

et al. 2011

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The objective of this study was to describe step by step our surgical technique of laminotomy and analyze our series with regard to spinal deformities (risk and predisposing factors), postoperative pain and rate of postoperative contusions. Data regarding patients who underwent our technique of laminotomy (N = 40, mean follow-up: 52 ms) (N = 40) between 2002 and 2006 were retrospectively evaluated. The technique used is illustrated in depth. Chronic pain was present in 30% with a mean score of 3/10 cm (Graphic Rating Scale). Postoperative kyphoses occurred in three patients, all below 35 years of age and with laminotomies which involved C2 and/or C7. None of these deformities required further surgical treatment because they were self-limiting or asymptomatic at a mean follow-up of 52 months. Based on the results, our technique proved to be safe and effective in terms of late deformities, blood loss, early and chronic postoperative pain and protection from postoperative accidents over the surgical site.

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“…Laminectomy will effectively decompress the spinal cord, but progressive kyphotic deformity and cervical instability are common in children after laminectomy. [19][20][21] In addition, the surgical scar on the posterior neck has generally gone unnoticed because it can easily be covered with hair. If progressive neurological deterioration occurs, laminoplasty with decompression of the spinal cord should be considered in patients with calcified intervertebral disc herniation.…”

Section: Discussionmentioning

confidence: 99%

Calcified intervertebral disc herniation in a child with myelopathy treated with laminoplasty

2005

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Study design: Case report. Objective: To describe a case of pediatric calcified intervertebral disc herniations at the cervical-thoracic junction surgically treated with laminoplasty. Methods: A 13-year-old girl with calcified intervertebral disc herniations at C7/Th1 and Th1/2 causing myelopathy was performed with laminoplasty . Results: Postoperative course was without complication, and the neurologic examination returned to a completely normal state at 5 years to date after surgery. Conclusions: Laminoplasty produced an excellent result and is a consideration for treatment of similar cases of calcified intervertebral disc herniation.Spinal Cord (2005) 43, 680-683.

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Incidence of spinal column deformity after multilevel laminectomy in children and adults

Cited by 357 publications

References 15 publications

Anterior approach versus posterior approach for the treatment of multilevel cervical spondylotic myelopathy: a systemic review and meta-analysis

Anterior approach versus posterior approach for the treatment of multilevel cervical spondylotic myelopathy: a systemic review and meta-analysis

Laminotomy in adults: technique and results

Calcified intervertebral disc herniation in a child with myelopathy treated with laminoplasty

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