Modified Plate-only Open-door Laminoplasty Versus Laminectomy and Fusion for the Treatment of Cervical Stenotic Myelopathy

Abstract

The purpose of this study was to compare modified plate-only laminoplasty and laminectomy and fusion to confirm which of the 2 surgical modalities could achieve a better decompression outcome and whether a significant difference was found in postoperative complications. Clinical data were retrospectively reviewed for 141 patients with cervical stenotic myelopathy who underwent plate-only laminoplasty and laminectomy and fusion between November 2007 and June 2010. The extent of decompression was assessed by measuring the cross-sectional area of the dural sac and the distance of spinal cord drift at the 3 most narrowed levels on T2-weighted magnetic resonance imaging. Clinical outcomes and complications were also recorded and compared. Significant enlargement of the dural sac area and spinal cord drift was achieved and well maintained in both groups, but the extent of decompression was greater in patients who underwent laminectomy and fusion; however, a greater decompression did not seem to produce a better clinical outcome. No significant difference was observed in Japanese Orthopaedic Association and Nurick scores between the 2 groups. Patients who underwent plate-only laminoplasty showed a better improvement in Neck Dysfunction Index and visual analog scale scores. In addition, limited decompression, rigid reconstruction of the spinal canal, and preservation of cervical mobility combined with preservation of the posterior structure resulted in a lower rate of postoperative C5 palsy and axial pain in the modified laminoplasty group. For this reason, modified laminoplasty may be a more viable option for patients with cervical stenotic myelopathy.

Laminoplasty versus laminectomy and fusion for multilevel cervical myelopathy: a meta-analysis of clinical and radiological outcomes

“…This different result in the subgroup analysis was caused by the relative weighting of the studies in the overall versus the long-term follow-up analysis. In the overall analysis, the studies of Zhang et al 19 and Lee et al 10 had very low weights (less than 2% for each), whereas in the long-term follow-up analysis they were weighted almost equally with the study of Yang et al 18 (approximately 30% each). The reason for this difference was that the study by Woods et al, 17 which had a very narrow standard deviation, was excluded in the long-term follow-up analysis.…”

“…5,11 Other studies addressing the superiority of one technique over the other have shown controversial results. 1,12,18,19 The aim of the present study was to compare improvements in myelopathy, the development of postoperative kyphosis, and the prevalence of axial pain in patients undergoing EL or LF by using a meta-analysis.…”

“…Finally, a total of 7 studies were included in the meta-analysis (6 English papers and 1 Chinese paper). 2,7,10,11,[17][18][19] The detailed selection process is shown in Fig. 1.…”

Relationship between the laminoplasty opening size and the laminoplasty opening angle, increased sagittal canal diameter and the prediction of spinal canal expansion following open-door cervical laminoplasty

“…Excellent longterm results have been reported using this technique [3][4][5][6][7]. Clinical follow-up studies have shown that laminoplasty generally results in greater patient satisfaction and lower complication rates than laminectomy [8][9][10][11][12].…”

A systematic review of clinical and surgical predictors of complications following surgery for degenerative cervical myelopathy

“…These studies were designed to compare the efficacy and complication rates between 2 different surgical interventions or varying techniques. Studies reported on differences between anterior and posterior approaches (n = 9); 15,18,19,22,30,42,44,48,59 laminoplasty and laminectomy and fusion (n = 4); 10,19,70,72 anterior decompression and Bryan disc (n = 1); 11 and anterior cervical discectomy and fusion (ACDF) and corpectomy (n = 2). 47,63 In addition, 11 studies compared laminoplasty techniques or considered technical differences such as laminoplasty with and without foraminotomy or muscle preservation.…”