Laminoplasty versus laminectomy and fusion for multilevel cervical spondylotic myelopathy

Abstract

Background: Cervical spondylotic myelopathy is increasingly prevalent in the elderly and is the leading cause of spinal cord dysfunction in this population. Laminectomy with fusion and laminoplasty halt progression of myelopathy in these patients; however, both procedures have well-documented complications and associated morbidity and it is unclear which might be most advantageous.

Questions/purposes: We therefore compared the pain, function and alignment of patients who underwent laminectomy with fusion to those with laminoplasty for the treatment of multilevel cervical spondylotic myelopathy.

Methods: We performed a retrospective matched cohort analysis on all 121 patients from 2002 to 2007 who underwent laminectomy with fusion (82) or laminoplasty (39) for multilevel cervical spondylotic myelopathy. We determined change in preoperative and postoperative sagittal alignment using Cobb measurement, development of junctional stenosis, and subjective improvements in pain and gait. Complications were recorded for both cohorts.

Results: The majority of patients in both cohorts reported improvements in pain and gait postoperatively. There were seven complications in the laminectomy and fusion cohort (9%) with two patients requiring formal revision surgery (2%). There were five complications in the laminoplasty cohort (13%) with two formal revision procedures (5%).

Conclusions: Patients in both the laminectomy with fusion and laminoplasty cohorts reported similar functional improvements after treatment for cervical spondylotic myelopathy. Prospective randomized control trials are needed to determine whether one procedure is truly superior.

Level of evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Fig. 1A–C

Images illustrate the case of a patient who initially underwent C3–C7 laminectomy and fusion due to progressive myeloradiculopathy. (A) His course was complicated by junctional stenosis, progressive cervicothoracic kyphosis, and recurrent neurologic symptoms. (B) Lateral radiographs before and (C) after show revision junctional laminectomies with C2–T2 posterior cervical fusion.

Fig. 2A–B

Images illustrate the case of a 51-year-old man who had C3–C7 laminoplasty for multilevel cervical stenosis. (A) Two years postoperatively, he developed uncovertebral spurs and recurrent radiculopathy. (B) He underwent C4–C5 anterior cervical discectomy and fusion with eventual relief of radicular symptoms.

Fig. 3A–C

Images illustrate the case of a 78-year-old woman who underwent C3–C7 laminectomy and fusion for multilevel cervical stenosis due to degenerative disc disease. (A) A postoperative radiograph shows appropriately placed hardware and lordotic sagittal alignment. (B) Two years later, the patient presented with recurrent symptoms and had substantially progressed multilevel disc degeneration. (C) The patient underwent revision junctional laminectomies with C2–T1 posterior fusion and had functional improvement postoperatively.