Laminectomy versus laminoplasty for treating multi-segmental cervical canal stenosis combined with central cord syndrome without fracture or dislocation (CCSWOFD):a retrospective study with a minimum follow-up period of two years

Abstract

Objective To conduct a comparative analysis on the clinical outcomes of two different posterior surgical procedures, namely laminectomy fusion fixation and single open-door laminoplasty, for the treatment of multi-segmental cervical canal stenosis accompanied by central cord syndrome without fractures or dislocations (CCSWOFD). Methods A total of 112 patients were recruited from our department between January 2012 and December 2021. The patients were divided into two groups: the LF group (n = 59), who underwent laminectomy fusion fixation, and the LP group (n = 53), who underwent single open-door laminoplasty. Comparative analysis was conducted on clinical outcomes and relevant radiological findings observed in both cohorts. Results The two groups did not show any significant differences in terms of intraoperative blood loss and length of hospital stay, with a p-value > 0.05. However, the LP group exhibited a significantly reduced surgical duration compared to the LF group, with a p-value < 0.05.The final follow-up revealed significant improvements in Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS) score, intrinsic hand muscle strength (IHMS) score, Brain and Spinal Injury Center (BASIC) score, and neurological recovery rate (RR), compared to the preoperative values for both groups (P < 0.05). The LF group demonstrated superior performance compared to the LP group in terms of final JOA score, RR, IHMS score, and BASIC score (P < 0.05). Conversely, although a significantly lower range of motion (ROM) was observed in the LF group compared to the LP group (P < 0.05), it exhibited a superior C2-7 Cobb angle. Additionally, while there was an increase in C2-7 sagittal vertical axis (SVA) after surgery in the laminoplasty (LP) group, it showed a significant decrease in the laminectomy (LF) group compared to that observed in the LP group (P < 0.05). No statistically significant differences were found between the two groups when considering K-line positivity with respect to their final JOA scores and VAS scores (P < 0.05). However, significantly better outcomes were observed for the LF group in terms of IHMS scores and RR (P < 0.05). In cases where K-line negativity was present, superior final JOA scores, IHMS scores, and RR were seen in the LF group compared to those observed in the LP group (P < 0.05). Nonetheless, there were no notable discrepancies between both groups concerning complications; furthermore, a low incidence of complications was noted within each group. Conclusion In terms of restoring neurological function, alleviating pain, enhancing motor ability, and reducing spinal cord edema, both laminectomy fusion fixation and single open-door laminoplasty have demonstrated efficacy as surgical options. However, when considering the achievement of better final C2-7SVA,C2-C7 Cobb angle, JOA score, IHMS score, RR and BASIC score, laminectomy fusion fixation surpasses single open-door laminoplasty. Despite the shorter surgical duration and preserved range of motion associated with single open-door laminoplasty, laminectomy fusion fixation is considered the optimal primary treatment for canal stenosis combined with central cord syndrome without fracture or dislocation (CCSWOFD), particularly in cases involving multi-segmental ossification of the posterior longitudinal ligament (OPLL) with K-line (-).