Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2019 Feb;98(8):e14651.
doi: 10.1097/MD.0000000000014651.

Comparison of clinical outcomes and safety between laminectomy with instrumented fusion versus laminoplasty for the treatment of multilevel cervical spondylotic myelopathy

Xiang Lin  1   2 , Jie Cai  2 , Chuan Qin  2 , Qinghua Yang  2 , Zengming Xiao  2
Affiliations
Meta-Analysis

Comparison of clinical outcomes and safety between laminectomy with instrumented fusion versus laminoplasty for the treatment of multilevel cervical spondylotic myelopathy

Xiang Lin et al. Medicine (Baltimore). 2019 Feb.

Abstract

Study design: Systematic review and meta-analysis.

Objectives: Posterior laminectomy with instrumented fusion and laminoplasty are widely used for the treatment of multilevel cervical spondylotic myelopathy (MCSM). There is great controversy over the preferred surgical method. The purpose of this study is to evaluate the clinical outcomes and safety between laminectomy with instrumented fusion and laminoplasty for the treatment of MCSM.

Methods: Related studies that compared the effectiveness of laminectomy with instrumented fusion and laminoplasty for the treatment of MCSM were acquired by a comprehensive search in PubMed, Embase, the Cochrane library, CNKI, VIP, and WANFANG up to April 2018. Included studies were evaluated according to eligibility criteria. The main endpoints included: preoperative and postoperative Japanese Orthopedic Association (JOA) scores, preoperative and postoperative visual analog scale (VAS), preoperative and postoperative cervical range of motion (ROM), preoperative and postoperative cervical curvature index (CCI), overall complication rate, C5 nerve palsy rate, axial symptoms rate, operation time and blood loss.

Results: A total of 15 studies were included in this meta-analysis. All of the selected studies were of high quality as indicated by the Newcastle-Ottawa scale (NOS). Among 1131 patients, 555 underwent laminectomy with instrumented fusion and 576 underwent laminoplasty. The results of this meta-analysis indicated no significant difference in preoperative and postoperative JOA scores, preoperative and postoperative VAS, preoperative and postoperative CCI, preoperative ROM and axial symptoms rate. However, compared with laminoplasty, laminectomy with instrumented fusion exhibited a higher overall complication rate [RR = 1.99, 95% confidence intervals (CI) (1.24, 3.21), P <.05], a higher C5 palsy rate [RR = 2.22, 95% CI (1.30, 3.80), P <.05], a decreased postoperative ROM [SMD = -1.51, 95% CI (-2.14, -0.88), P <.05], a longer operation time [SMD = 0.51, 95% CI (0.12, 0.90), P <.05] and increased blood loss [SMD = 0.47, 95% CI (0.30, 0.65), P <.05].

Conclusion: These results suggested that both posterior laminectomy with instrumented fusion and laminoplasty were determined to be effective for MCSM. However, laminoplasty appeared to allow for a greater ROM, lower overall complication and C5 palsy rates, shorter operation time and lower blood loss. Future well-designed, randomized controlled trials are still needed to further confirm our results.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no conflicts of interest concerning this article.

Figures

Figure 1
Figure 1
The flow chart showing the article selection process.
Figure 2
Figure 2
Forest plot of preoperative JOA scores between the LIF group and the LMP group. JOA = Japanese Orthopedic Association, LIF = laminectomy with instrumented fusion, LMP = laminoplasty.
Figure 3
Figure 3
Forest plot of postoperative JOA scores between the LIF group and the LMP group. JOA = Japanese Orthopedic Association, LIF = laminectomy with instrumented fusion, LMP = laminoplasty.
Figure 4
Figure 4
Forest plot of preoperative VAS scores between the LIF group and the LMP group. LIF = laminectomy with instrumented fusion, LMP = laminoplasty, VAS = visual analog scale.
Figure 5
Figure 5
Forest plot of postoperative VAS scores between the LIF group and the LMP group. LIF = laminectomy with instrumented fusion, LMP = laminoplasty, VAS = visual analog scale.
Figure 6
Figure 6
Forest plot of preoperative CCI between the LIF group and the LMP group. CCI = cervical curvature index, LIF = laminectomy with instrumented fusion, LMP = laminoplasty.
Figure 7
Figure 7
Forest plot of postoperative CCI between the LIF group and the LMP group. CCI = cervical curvature index, LIF = laminectomy with instrumented fusion, LMP = laminoplasty.
Figure 8
Figure 8
Forest plot of preoperative ROM between the LIF group and the LMP group. LIF = laminectomy with instrumented fusion, LMP = laminoplasty, ROM = range of motion.
Figure 9
Figure 9
Forest plot of postoperative ROM between the LIF group and the LMP group. LIF = laminectomy with instrumented fusion, LMP = laminoplasty, ROM = range of motion.
Figure 10
Figure 10
Forest plot of C5 nerve palsy rate between the LIF group and the LMP group. LIF = laminectomy with instrumented fusion, LMP = laminoplasty.
Figure 11
Figure 11
Forest plot of axial symptoms rate between the LIF group and the LMP group. LIF = laminectomy with instrumented fusion, LMP = laminoplasty.
Figure 12
Figure 12
Forest plot of overall complication rate between the LIF group and the LMP group. LIF = laminectomy with instrumented fusion, LMP = laminoplasty.
Figure 13
Figure 13
Forest plot of operation time between the LIF group and the LMP group. LIF = laminectomy with instrumented fusion, LMP = laminoplasty.
Figure 14
Figure 14
Forest plot of blood loss between the LIF group and the LMP group. LIF = laminectomy with instrumented fusion, LMP = laminoplasty.
Figure 15
Figure 15
Funnel plots for preoperative JOA scores. JOA = Japanese Orthopedic Association.
Figure 16
Figure 16
Funnel plots for postoperative JOA scores. JOA = Japanese Orthopedic Association.
Figure 17
Figure 17
Funnel plots for preoperative VAS scores. VAS = visual analog scale.
Figure 18
Figure 18
Funnel plots for postoperative VAS scores. VAS = visual analog scale.
See this image and copyright information in PMC

References

    1. Karadimas SK, Gatzounis G, Fehlings MG. Pathobiology of cervical spondylotic myelopathy. Eur Spine J 2015;24:132–8. - PubMed
    1. Rao RD, Gourab K, David KS. Operative treatment of cervical spondylotic myelopathy. J Bone Joint Surg Am 2006;88:1619–40. - PubMed
    1. Xu L, Sun H, Li Z, et al. Anterior cervical discectomy and fusion versus posterior laminoplasty for multilevel cervical myelopathy: a meta-analysis. Int J Surg 2017;48:247–53. - PubMed
    1. Rhee JM, Basra S. Posterior surgery for cervical myelopathy: laminectomy, laminectomy with fusion, and laminoplasty. Asian Spine J 2008;2:114–26. - PMC - PubMed
    1. Hirabayashi K, Watanabe K, Wakano K, et al. Expansive open-door laminoplasty for cervical spinal stenotic myelopathy. Spine (Phila Pa 1976) 1983;8:693–9. - PubMed

MeSH terms