Skip laminectomy and laminoplasty for cervical spondylotic myelopathy: a prospective study of clinical and radiologic outcomes

Abstract

Study design: A prospective nonrandomized study comparing the outcomes of the 2 surgical techniques used in the treatment of cervical spondylotic myelopathy.

Objective: We prospectively compared the skip laminectomy and laminoplasty in terms of extent of decompression achieved, axial pain, postoperative range of cervical motion, and patient and surgical outcomes.

Summary of background data: Laminoplasty is an established procedure for the decompression of multisegmental cervical compressive myelopathy. However, it often induces postoperative problems, such as axial pain, restriction of neck motion, and loss of lordotic alignment. Skip laminectomy was recently developed as a minimally invasive procedure.

Methods: We studied 50 consecutive patients operated on for cervical spondylotic myelopathy and spinal cord compression as demonstrated on magnetic resonance imaging (MRI) between the levels C3-4 and C6-7. Each patient had a minimum follow-up of 2 years (2.2 to 4.3 y). Twenty-five patients underwent skip laminectomy and 25 patients underwent laminoplasty. Decompression was assessed by preoperative and postoperative MRI. Cervical range of motion was assessed by preoperative and postoperative flexion and extension radiographs. Patient outcomes were assessed by evaluation of preoperative and postoperative neurology and SF12 scores for mental health, physical health, and axial pain.

Results: Less blood loss and operative times with skip laminectomy. Similar degrees of decompression with both techniques. Significantly improved axial pain scores with skip laminectomy. Significantly improved preservation of range of movement with skip laminectomy.

Conclusions: Skip laminectomy is an effective procedure for reducing the incidence of postoperative morbidities, such as persisting axial pain, and restriction of neck motion often seen after laminoplasty, and provides adequate decompression of the spinal cord as demonstrated on MRI for a minimum follow-up of 2 years.