Laminoplasty—an underutilized procedure for cervical spondylotic myelopathy

Lopez, Wylie Y.; Goh, Brian C.; Upadhyaya, Shivam; Ziino, Chason; Georgakas, Peter J.; Gupta, Anmol; Tobert, Daniel G.; Fogel, Harold A.; Thomas, D.; Schwab, Joseph H.; Bono, Christopher M.; Hershman, Stuart H.

doi:10.1016/j.spinee.2020.10.021

Cited by 23 publications

(19 citation statements)

References 34 publications

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“…[14][15][16][17] This is consistent with previous studies that have suggested that LP is an underutilized procedure based on radiographic criteria. 18 In addition, this study also found that in a matched analysis, LF was associated with higher rates of wound complications and surgical site infections, dysphagia, cervicalgia, development of cervical kyphosis, limb paralysis, and other medical complications such as respiratory issues, renal failure, and sepsis. However, at each time point examined, the rate of revision surgery was similar between the two groups.…”

Section: Discussionsupporting

confidence: 52%

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Cervical Laminoplasty Versus Posterior Laminectomy and Fusion: Trends in Utilization and Evaluation of Complication and Revision Surgery Rates

McDonald

Hershman

Alsoof

et al. 2022

J Am Acad Orthop Surg

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Introduction: Cervical laminoplasty (LP) and laminectomy with fusion (LF) are common operations used to treat cervical spondylotic myelopathy. Conflicting data exist regarding which operation provides superior patient outcomes while minimizing the risk of complications. This study evaluates the trends of LP compared with LF over the past decade in patients with cervical myelopathy and examines long-term revision rates and complications between the two procedures. Methods: Patients aged 18 years or older who underwent LP or LF for cervical myelopathy from 2010 to 2019 were identified in the PearlDiver Mariner Database. Patients were grouped independently (LP versus fusion) and assessed for association with common medical and surgical complications. The primary outcome was the incidence of LP versus LF for cervical myelopathy over time. Secondary outcomes were revision rates up to 5 years postoperatively and the development of complications attributable to either surgery. Results: In total, 1,420 patients underwent LP and 10,440 patients underwent LF. Rates of LP (10.5% to 13.7%) and LF (86.3% to 89.5%) remained stable, although the number of procedures nearly doubled from 865 in 2010 to 1,525 in 2019. On matched analysis, LP exhibited lower rates of wound complications, surgical site infections, spinal cord injury, dysphagia, cervical kyphosis, limb paralysis, incision and drainage/ exploration, implant removal, respiratory failure, renal failure, and sepsis. Revision rates for both procedures at were not different at any time point. Conclusion: From 2010 to 2019, rates of LP have not increased and represent less than 15% of posterior-based myelopathy operations. Up to 5 years of follow-up, there were no differences in revision rates for LP compared with LF; however, LP was associated with fewer postoperative complications than LF.

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Section: Discussionsupporting

confidence: 52%

“…14-17 This is consistent with previous studies that have suggested that LP is an underutilized procedure based on radiographic criteria. 18…”

Section: Discussionmentioning

confidence: 99%

Cervical Laminoplasty Versus Posterior Laminectomy and Fusion: Trends in Utilization and Evaluation of Complication and Revision Surgery Rates

McDonald

Hershman

Alsoof

et al. 2022

J Am Acad Orthop Surg

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“…However, for the anterior cervical surgery with long segments, especially the anterior cervical surgery fixed with a long titanium cage and anterior long titanium plate, the normal biomechanical state of the cervical spine will be significantly changed. Therefore, it is considered to increase the risk of adjacent segment degeneration after surgery [ 10 ]. Although there are pathological changes in multiple plane vertebral body, disc, spinal canal, and spinal cord in long segment CS, there is no consistent understanding of whether they can cause clinical symptoms, whether phase I surgical decompression is needed, or which surgical choice is needed [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical Efficacy and Safety of Anterior Cervical Decompression versus Segmental Fusion and Posterior Expansive Canal Plasty in the Treatment of Multilevel Cervical Spondylotic Myelopathy

Xia

Shi

Chen

et al. 2022

Journal of Healthcare Engineering

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Objective. To compare the clinical efficacy and safety of anterior cervical decompression and segmental fusion and posterior expansive canal plasty in the treatment of multisegment cervical myelopathy. Methods. Retrospective analysis was performed of 56 cases of multisegment cervical myelopathy patients admitted from July 2018 to June 2021, 32 male patients and 24 females, aged 56.9 ± 12.8 years with an average duration of 10.6 ± 3.2 years. All patients' preoperative imaging examination revealed multiple-segmented cervical disc herniation and had clinical manifestations of cervical myelopathy. Results. No neurovascular complications occurred in both groups, and 24 to 36 months of follow-up (mean 28.6 months) were obtained. The height of the cervical spondylosis segment was higher than that 2 weeks after surgery ( p < 0.05 ), and the curvature of the cervical spine was significantly lower than that before surgery. There was no statistical significance in the height of the anterior column and curvature of the cervical vertebra at 2 weeks after surgery and at the last follow-up ( p > 0.05 ). There were statistically significant differences in anterior curvature of the cervical spine between the two groups at 2 weeks after surgery and the last follow-up ( p < 0.05 ). Japanese Orthopaedic Association (JOA) scores in both groups recovered significantly after surgery. At 3 months and the last follow-up, the improvement rate of JOA score in the anterior approach group was significantly higher than that in the posterior approach group ( p < 0.05 ), and the improvement rate of JOA score in the anterior approach group was also better than that in the posterior approach group ( p < 0.05 ). Conclusion. This segmented anterior fusion procedure can effectively restore the anterior cervical column height and can significantly improve spinal cord function compared with posterior spinal canal enlargement plasty, thus could be considered an effective option for the treatment of multisegment cervical myelopathy.

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“…Many factors should be considered when deciding on the surgical approach and mode for patients with DCM, and the factors to consider include the clinical symptoms, signs, imaging findings (cervical spinal cord compression factors and responsible segments, degeneration range, cervical curvature and stability), possible surgical complications, operative habits of the surgeons, medical expenses, etc. [ 12 , 13 , 14 ]. In our study, 284 patients with DCM treated with different surgical methods were enrolled.…”

Section: Discussionmentioning

confidence: 99%

The Pre-Operative Duration of Symptoms: The Most Important Predictor of Post-Operative Efficacy in Patients with Degenerative Cervical Myelopathy

Guo

Lin

et al. 2022

Brain Sciences

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Objective. To explore the most important predictors of post-operative efficacy in patients with degenerative cervical myelopathy (DCM). Methods. From January 2013 to January 2019, 284 patients with DCM were enrolled. They were categorized based on the different surgical methods used: single anterior cervical decompression and fusion (ACDF) (n = 80), double ACDF (n = 56), three ACDF (n = 13), anterior cervical corpectomy and fusion (ACCF) (n = 63), anterior cervical hybrid decompression and fusion (ACHDF) (n = 25), laminoplasty (n = 38) and laminectomy and fusion (n = 9). The follow-up time was 2 years. The patients were divided into two groups based on the mJOA recovery rate at the last follow-up: Group A (the excellent improvement group, mJOA recovery rate >50%, n = 213) and Group B (the poor improvement group, mJOA recovery rate ≤50%, n = 71). The evaluated data included age, gender, BMI, duration of symptoms (months), smoking, drinking, number of lesion segments, surgical methods, surgical time, blood loss, the Charlson Comorbidity Index (CCI), CCI classification, imaging parameters (CL, T1S, C2-7SVA, CL (F), T1S (F), C2-7SVA (F), CL (E), T1S (E), C2-7SVA (E), CL (ROM), T1S (ROM) and C2-7SVA (ROM)), maximum spinal cord compression (MSCC), maximum canal compromise (MCC), Transverse area (TA), Transverse area ratio (TAR), compression ratio (CR) and the Coefficient compression ratio (CCR). The visual analog score (VAS), neck disability index (NDI), modified Japanese Orthopedic Association (mJOA) and mJOA recovery rate were used to assess cervical spinal function and quality of life. Results. We found that there was no significant difference in the baseline data among the different surgical groups and that there were only significant differences in the number of lesion segments, C2–7SVA, T1S (F), T1S (ROM), TA, CR, surgical time and blood loss. Therefore, there was comparability of the post-operative recovery among the different surgical groups, and we found that there were significant differences in age, the duration of symptoms, CL and pre-mJOA between Group A and Group B. A binary logistic regression analysis showed that the duration of the symptoms was an independent risk factor for post-operative efficacy in patients with DCM. Meanwhile, when the duration of symptoms was ≥6.5 months, the prognosis of patients was more likely to be poor, and the probability of a poor prognosis increased by 0.196 times for each additional month of symptom duration (p < 0.001, OR = 1.196). Conclusion. For patients with DCM (regardless of the number of lesion segments and the proposed surgical methods), the duration of symptoms was an independent risk factor for the post-operative efficacy. When the duration of symptoms was ≥6.5 months, the prognosis of patients was more likely to be poor, and the probability of a poor prognosis increased by 0.196 times for each additional month of symptom duration (p < 0.001, OR = 1.196).

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Laminoplasty—an underutilized procedure for cervical spondylotic myelopathy

Cited by 23 publications

References 34 publications

Cervical Laminoplasty Versus Posterior Laminectomy and Fusion: Trends in Utilization and Evaluation of Complication and Revision Surgery Rates

Cervical Laminoplasty Versus Posterior Laminectomy and Fusion: Trends in Utilization and Evaluation of Complication and Revision Surgery Rates

Clinical Efficacy and Safety of Anterior Cervical Decompression versus Segmental Fusion and Posterior Expansive Canal Plasty in the Treatment of Multilevel Cervical Spondylotic Myelopathy

The Pre-Operative Duration of Symptoms: The Most Important Predictor of Post-Operative Efficacy in Patients with Degenerative Cervical Myelopathy

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