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Results of Laminoplasty for Cervical Spondylotic Myelopathy Comparable to Other Procedures

Cervical spondylotic myelopathy is a common neck (spinal cord) problem among people who are over 55 years old. It occurs when the spinal cord becomes compressed because of changes to the spine and sometimes because of bone spurs that form. When the condition progresses to moderate or becomes severe, surgery is usually the only option to provide relief and improve movement.

Opinions on the type of surgery used to treat cervical spondylotic myelopathy differ between specialists. Some feel that the best approach is from the front anterior cervical discectomy and fusing the bones, while others feel that a corpectomy, removal of some of the vertebrae and fusion is the way to go. Yet other surgeons go for an approach from the back of the neck, a posterior surgery that includes laminoplasty (repositioning of the vertebrae) or laminectomy (removing part of the vertebrae), along with fusing the bones together. Because the population in the United States is aging and people are living longer, these types of surgeries will become increasingly common. For this reason, it is important to know which, if any, approach is better, to increase the chances of good outcomes. The authors of this study reviewed the different approaches to see if one was better than the other, in order to help surgeons with their decisions regarding the surgery to be done.

Researchers went through the medical literature to find studies that looked at the targeted surgical procedures, from 1980 to 2008. A separate review was done of 10-year follow-ups. Seven articles were found that were used for this review and three for the 10-year follow-up review. None of the studies included a randomized controlled study, where neither the patients nor the investigators know what type of surgery is being performed. The follow-up articles were case studies.

Four studies compared corpectomy to laminoplasty. Following the surgeries, the reports showed similar results from both surgical procedures in terms of neurological (nerve) damage and recovery rate, but two studies did find a significant difference in the range of motion after surgery. The patients who had undergone a laminoplasty had better range of motion than those who had a corpectomy. There was also a difference in pain outcomes. Patients reported more pain after laminoplasty than corpectomy (40 to 60 percent versus 15 to 19 percent). In reviewing complications, more were found in the corpectomy group and seemed to be related to where the surgery entry was (anterior or posterior). However, there were also complications in some patients related to the grafting or the bones not joining. The complications seen with some laminoplasties involved nerve damage, but all were resolved.

Two studies compared anterior cervical discectomy and laminoplasty. The only differences found between these procedures was a higher rate of spondyloptosis (vertebrae slips forward) in the patients in the first group. Only one study compared laminectomies with laminoplasties. In this study, the only significant differences were a decreased range of motion after surgery with the laminectomies, compared with the laminoplasties, and five patients in the laminoplasty group had non union of the bones. There were eight serious complications among the laminectomy group including two patients getting worse, two patients experiencing a breakage of instruments, one patient requiring further surgery, one having a deep infection, and one having graft site pain. No complications were reported in the other group.

When reviewing the studies involving the 10-year or more follow-ups, the researchers looked at three case series. All showed that limited range of motion and neck pain continued to be a problem among some patients who had undergone laminoplasties. Some patients who underwent a corpectomy also had continued neck pain, but not in as high a number as the laminoplasty group.

The researchers concluded that the laminoplasty is a good option for treatment of cervical spondylotic myelopathy, with generally fewer complications than the other surgeries described in this article. However, there is also a higher incidence of neck pain among this group.


Mary R.A. Cunningham, MD, Stuart Hershman, MD, and John Bendo, MD. Systematic Review of Cohort Studies Comparing Surgical Treatments for Cervical Spondylotic Myelopathy. In Spine. March 1, 2010. Vol. 35, No. 5. Pp. 537-543.

03/25/2010

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