The Safety and Efficacy of Cervical Laminectomy and Fusion versus Cervical Laminoplasty Surgery in Degenerative Cervical Myelopathy: A Prospective Randomized Trial

Abstract

BACKGROUND: There is a lack of evidence of whether degenerative cervical myelopathy (DCM) is best treated through cervical laminoplasty (CLP) or cervical laminectomy with lateral mass fusion due to the lack of prospective randomized studies that are well designed. We conducted the largest prospective randomized trial to date to determine the comparative effectiveness and safety of both approaches.
 METHODS: In this prospective, randomized trial, we randomly assigned patients who had symptoms or signs of DCM to undergo either cervical laminectomy and lateral mass fixation (CLF) or CLP. The primary outcome measures were the change in the Visual Analog Scale (VAS), neck disability index, modified Japanese Orthopedic Association (mJOA) score, and Nurick’s myelopathy grading 1 year after surgery. The secondary outcome measures were the intraoperative, post-operative complications, hospital stay, C2-7 Cobb’s angle, and Odom’s criteria. The follow-up period was at least 1 year.
 RESULTS: A total of 30 patients (mean age, 54.5 ± 5.5 years, 70% of men) underwent prospective randomization. There was a significantly greater improvement in neck pain (VAS) in the CLF group at 1 year (p < 0.05). The improvement in the mJOA and Nurick’s myelopathy grading showed insignificant improvement between both groups. Furthermore, there was no significant difference in the patient’s post-operative satisfaction (Odom’s criteria). The mean operative time was significantly longer in the CLF group (p < 0.001), with no significant difference in the post-operative complications, however, there was a higher rate of C5 palsy, dural tear and infection in the CLF, and a higher rate of instrumentation failure in the CLP. The mean hospital stay was significantly longer in the posterior group (p < 0.05). Finally, there was a significant better improvement in the C2-7 Cobb’s angle at 1 year in the CLF group (p < 0.05).
 CONCLUSION: Among patients with multilevel DCM, the CLF approach was significantly better regarding the post-operative pain and Cobb’s angle while the CLP was significantly better in terms of shorter hospital stay and operative time.

Laminoplasty versus laminectomy with fusion for treating multilevel degenerative cervical myelopathy

“…There was no significant difference in reported pain between groups at each post-op interval up to 24 months. The average improvement in overall pain was slightly greater in the LF group (1.8 points compared to 0.8 points for the LP group); however, this difference is likely attributed to a trend of greater baseline pain in the LF group, Other studies have seen a similar pattern of slightly greater pain improvement with LF in the setting of higher pain at baseline [16 , 17] . This phenomenon remains difficult to interpret due to the wide range of values of VAS score changes published by other comparison studies, varying between 0.2 and 4 points; in contrast, other studies observed greater pain improvement after LP [18] .…”