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Meta-Analysis
. 2019 Mar;98(13):e14971.
doi: 10.1097/MD.0000000000014971.

Comparison of laminectomy and fusion vs laminoplasty in the treatment of multilevel cervical spondylotic myelopathy: A meta-analysis

Xiaojun Yuan  1 , Chunmei Wei  2 , Wenhua Xu  1 , Xinrong Gan  1 , Shengsheng Cao  1 , Jiaquan Luo  3
Affiliations
Meta-Analysis

Comparison of laminectomy and fusion vs laminoplasty in the treatment of multilevel cervical spondylotic myelopathy: A meta-analysis

Xiaojun Yuan et al. Medicine (Baltimore). 2019 Mar.

Abstract

Purpose: The purpose of this study is to evaluate the clinical safety and efficacy between laminectomy and fusion (LF) versus laminoplasty (LP) for the treatment of multi-level cervical spondylotic myelopathy (CSM).

Methods: The authors searched electronic databases using PubMed, MEDLINE, Embase, Cochrane Controlled Trial Register, and Google Scholar for relevant studies that compared the clinical effectiveness of LF and LP for the treatment of patients with multilevel CSM. The following outcome measures were extracted: the Japanese Orthopaedic Association (JOA) scores, cervical curvature index (CCI), visual analog scale (VAS), Nurich grade, reoperation rate, complications, rate of nerve palsies. Newcastle Ottawa Quality Assessment Scale (NOQAS) was used to evaluate the quality of each study. Data analysis was conducted with RevMan 5.3.

Results: A total of 14 studies were included in our meta-analysis. No significant difference was observed in terms of postoperative Japanese Orthopaedic Association score (P = .29), visual analog scale neck pain (P = .64), cervical curvature index (P = .24), Nurich grade (P = .16) and reoperation rate (P = .21) between LF and LP groups. Compared with LP group, the total complication rate (OR 2.60, 95% CI 1.85, 3.64, I = 26%, P < .00001) and rate of nerve palsies (OR 3.18, 95% CI 1.66, 6.11, I = 47%, P = .0005) was higher in the LF group.

Conclusions: Our meta-analysis reveals that surgical treatments of multilevel CSM are similar in terms of most clinical outcomes using LF and LP. However, LP was found to be superior than LF in terms of nerve palsy complications. This requires further validation and investigation in larger sample-size prospective and randomized studies.

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Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Figures

Figure 1
Figure 1
The flow diagram showing the article selection process we performed.
Figure 2
Figure 2
Forest plot of postoperative JOA scores (a) and neck VAS score (b) between LF and LP groups. JOA = Japanese Orthopaedic Association, LF = laminectomy and fusion, LP = laminoplasty, VAS = visual analog scale.
Figure 3
Figure 3
Forest plot of postoperative CCI (a) and Nurich grade (b) between LF and LP groups. CCI = cervical curvature index, LF = laminectomy and fusion, LP = laminoplasty.
Figure 4
Figure 4
Forest plot of postoperative complications (a), reoperation rate (b) and nerve palsies (c) between LF and LP groups. LF = laminectomy and fusion, LP = laminoplasty.
Figure 5
Figure 5
Funnel plots for postoperative JOA (a), VAS (b), CCI (c), Nurich grade (d), total complication rates (e), reoperations (f), and nerve palsy (g). CCI = cervical curvature index, JOA = Japanese Orthopaedic Association, VAS = visual analog scale.
See this image and copyright information in PMC

References

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