Laminoplasty versus laminectomy with fusion for the treatment of spondylotic cervical myelopathy: short-term follow-up

Blizzard, Daniel J.; Caputo, Adam M.; Sheets, Charles; Klement, Mitchell R.; Michael, Keith W.; Isaacs, Robert E.; Brown, Christopher R.

doi:10.1007/s00586-016-4746-3

Cited by 72 publications

(75 citation statements)

References 37 publications

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“…Patients after ACCDF (16.8%, 95% CI 6.9%–27.2%) and ACDF (16.2%, 95% CI 11.7%–19.8%) had higher incidence than those who received ACCF (9.9%, 95% CI 4.8%–15.9%). Multifactors as reported by recent studies, [63,68–71,75–80] hematoma, pharyngeal plexus denervation, vocal cord paralysis, adhesion formation, plate profile, and swelling due to biologic agents, may be related to dysphagia. Brad [99] indicated that a no-profile cervical disc arthroplasty had a significantly lower rate of dysphagia compared with ACDF.…”

Section: Discussionmentioning

confidence: 82%

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Prevalence of complications after surgery in treatment for cervical compressive myelopathy

et al. 2017

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Purpose:We aim to perform a meta-analysis on prevalence of all kinds of operation-related complications following surgery treating cervical compressive myelopathy (CCM) and to provide reference for surgeons making surgical plan.Methods:An extensive search of literature was performed in PubMed/MEDLINE, Embase, the Cochrane library, CNKI, and WANFANG databases on incidence of operation-related complications from January 2007 to November 2016. Data was calculated and data analysis was conducted with STATA 12.0 and Revman 5.3.Results:A total of 107 studies included 1705 of 8612 patients (20.1%, 95% CI 17.3%–22.8%) on overall complications. The incidence of C5 plasy, cerebrospinal fluid (CSF), infection, axial pain, dysphagia, hoarseness, fusion failure, graft subsidence, graft dislodgment, and epidural hematoma is 5.3% (95% CI 4.3%–6.2%), 1.9% (95% CI 1.3%–2.4%), 2.8% (95% CI 1.7%–4.0%), 15.6% (95% CI 11.7%–19.5%), 16.8% (95% CI 13.6%–19.9%), 4.0% (95% CI 2.3%–5.7%), 2.6% (95% CI 0.2%–4.9%), 3.7% (95% CI 2.0%–5.5%), 3.4% (95% CI 2.0%–4.8%), 1.1% (95% CI 0.7%–1.5%), respectively. Patients with ossification of posterior longitudinal ligament (OPLL) (6.3%) had a higher prevalence of C5 plasy than those with cervical spondylotic myelopathy (CSM) (4.1%), and a similar trend in CSF (12.2% vs 0.9%). Individuals after laminectomy and fusion (LF) had highest rate of C5 plasy (15.2%), while those who underwent anterior cervical discectomy and fusion (ACDF) had the lowest prevalence (2.0%). Compared with patients after other surgical options, individuals after anterior cervical corpectomy and fusion (ACCF) have the highest rate of CSF (4.2%), infection (14.2%), and epidural hematoma (3.1%). Patients after ACDF (4.8%) had a higher prevalence of hoarseness than those with ACCF (3.0%), and a similar trend for dysphagia between anterior corpectomy combined with discectomy (ACCDF) and ACCF (16.8% vs 9.9%).Conclusions:Based on our meta-analysis, patients with OPLL have a higher incidence of C5 palsy and CSF. Patients after LF have a higher incidence of C5 palsy, ACCDF have a higher incidence of dysphagia, ACCF have a higher incidence of CSF and infection and ACDF have a higher incidence of hoarseness. These figures may be useful in the estimation of the probability of complications following cervical surgery.

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Section: Discussionmentioning

confidence: 82%

“…Twenty-five studies [20,23–25,33,35,36,40,47,51,59,61,62,68,69,73–76,78,85,86,91,117,118] containing 142 patients with infection of 3489 patients after cervical surgery were included. Figure 21 shows that the incidence was 2.8% (95% CI 1.7%–4.0%), with substantial heterogeneity of incidence observed.…”

Section: Resultsmentioning

confidence: 99%

Prevalence of complications after surgery in treatment for cervical compressive myelopathy

et al. 2017

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“…Several reports have described reductions in ROM of 30% to 70% of the preoperative ROM after cervical laminoplasty 6,20) . Blizzard et al reported that the ROM was reduced by up to 27.11% of the preoperative ROM after cervical LF 2) . In our study, patients in the cervical LF group experienced a significant reduction in ROM compared with those in the EL group.…”

Section: Rommentioning

confidence: 96%

“…Posterior decompression surgeries such as cervical expansive laminoplasty (EL) or laminectomy with fusion (LF) have been widely performed to adequately decompress the spinal cord, although they cannot directly remove ossification of the posterior longitudinal ligament (OPLL) 2,7,11) . In patients with cervical myelopathy with OPLL in more than three segments, posterior decompression is more attractive than anterior decompression because this procedure can avoid the need for an anterior route or major strut graft-related problems, such as cerebrospinal fluid leakage, pseudoarthrosis, or graft dislodgment 26,31) .…”

Section: Introductionmentioning

confidence: 99%

Cervical Expansive Laminoplasty versus Laminectomy with Fusion for Cervical Ossification of the Posterior Longitudinal Ligament (OPLL)

et al. 2018

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Objective: The purpose was to comparatively assess cervical sagittal alignment and health-related quality of life (HRQOL) outcomes, between patients who underwent cervical expansive laminoplasty (EL) and those who underwent cervical laminectomy with fusion (LF) for cervical ossification of the posterior longitudinal ligament (OPLL) in more than three levels. Methods: We retrospectively evaluated consecutive patients with cervical OPLL undergoing posterior cervical decompression from 2013-2015. We analyzed radiological measurements (C2-7 sagittal vertical axis [C2-7 SVA], C0-2 angle, C2-7 lordotic angle, T1 slope, and range of motion [ROM]) and clinical outcomes (visual analog scale, neck disability index, Short Form-36, and Japanese Orthopaedic Association scores), preoperatively and at the last follow-up. Results: There were 84 patients (63 men; 21 women). Mean follow-up period was 27.7 months (range: 24-48.8). Compared with preoperative C2-7 SVA, postoperative C2-7 SVA was significantly increased in patients in the LF (13.46 mm) and EL (2.11 mm) groups. Losses of the cervical lordotic angle and ROM were larger in cervical LF patients than in cervical EL patients. The change in the C2-7 SVA was negatively correlated with the change in the C2-7 lordotic angle and positively correlated with changes in the T1 slope and C0-2 angle. Improvements in health-related quality of life were similar between the two groups, except for patient-reported neck pain. Conclusion: Cervical EL and LF were effective surgical techniques to improve the patient-reported outcomes and HRQOL of patients with OPLL in more than three levels. Cervical EL can preserve sagittal alignment and improve clinical results and neck pain, more than cervical LF. Cervical sagittal imbalance after posterior decompression was related to axial neck pain.

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“…Eine Überlegenheit eines Verfahrens hinsichtlich der Verbesserung der klinischen Symptomatik und der postoperativen Stellung der Halswirbelsäule, hier insbesondere der Ausbildung einer Kyphose, findet sich nicht. Allerdings gibt es Hinweise dass die Komplikationsquote bei Laminektomie plus Fusion höher ist als bei der Laminoplastie [19]. Ein neues posteriores Verfahren ist die unilaterale Laminotomie/Hemilaminektomie mit bilateraler Dekompression in Undercutting-Technik [20]; hier stehen allerdings noch belastbare klinische und radiologische Daten aus.…”

Section: Operative Therapie Bei Zervikaler Spondylose: Posteriore Verunclassified

Der zervikale Bandscheibenvorfall – Spontanverlauf, Therapieoptionen und klinische Ergebnisse

Rohde

2019

Die Wirbelsäule

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ZusammenfassungDie alters- und belastungsabhängige Degeneration der Halsbandscheibe kann zu einem weichen Halsbandscheibenvorfall führen oder eine Kaskade weiterer Prozesse auslösen, welche in einen harten Bandscheibenvorfall, die zervikale Spondylose, einmünden. Während ein Wurzelreiz- oder Wurzelkompressionssyndrom die vorherrschende Symptomatik beim weichen Bandscheibenvorfall ist, dominiert bei der zervikalen Spondylose die Myelopathie. Bildgebende Verfahren zur Diagnosestellung sind die Magnetresonanztomographie (MRT) und Computertomographie (CT), bei geplanter Operation gegebenenfalls ergänzt durch Röntgenaufnahmen in Neutral-, Flexions- und Extensionsstellung. Bei einem weichen Bandscheibenvorfall besteht eine Operationsindikation bei einem therapieresistenten radikulären Schmerzsyndrom oder einer myotombezogenen Parese. Bei einer zervikalen Spondylose ist spätestens bei Nachweis einer moderaten Myelopathie eine Operation unumgänglich. Es existieren sowohl für den weichen Bandscheibenvorfall als auch für die zervikale Spondylose etablierte anteriore und posteriore Operationsverfahren. Auch wenn es in Deutschland eine deutliche Präferenz für anteriore Verfahren gibt, konnte bislang keine Überlegenheit eines Verfahrens sowohl hinsichtlich Symptomkontrolle als auch hinsichtlich Komplikationsquote gezeigt werden.

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Laminoplasty versus laminectomy with fusion for the treatment of spondylotic cervical myelopathy: short-term follow-up

Cited by 72 publications

References 37 publications

Prevalence of complications after surgery in treatment for cervical compressive myelopathy

Prevalence of complications after surgery in treatment for cervical compressive myelopathy

Cervical Expansive Laminoplasty versus Laminectomy with Fusion for Cervical Ossification of the Posterior Longitudinal Ligament (OPLL)

Der zervikale Bandscheibenvorfall – Spontanverlauf, Therapieoptionen und klinische Ergebnisse

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