The Relative Merits of Posterior Surgical Treatments for Multi-Level Degenerative Cervical Myelopathy Remain Uncertain: Findings from a Systematic Review

Xiaoyu Yang^{1

2}, Aref-Ali Gharooni¹, Rana S Dhillon³, Edward Goacher⁴, Edward W Dyson⁵, Oliver Mowforth¹, Alexandru Budu⁶, Guy Wynne-Jones⁷, Jibin Francis¹, Rikin Trivedi¹, Marcel Ivanov⁶, Sashin Ahuja⁸, Kia Rezajooi⁹, Andreas K Demetriades¹⁰, David Choi¹¹, Antony H Bateman¹², Nasir Quraishi¹³, Vishal Kumar¹⁴, Manjul Tripathi¹⁵, Sandeep Mohindra¹⁵, Erlick A Pereira¹⁶, Giles Critchley¹⁷, Michael G Fehlings¹⁸, Peter J A Hutchinson¹, Benjamin M Davies¹, Mark R N Kotter^{1

19}

Affiliations

¹ Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge CB0 0GG, UK.
² Department of Neurosurgery, Leiden University Medical Centre, 2333ZA Leiden, The Netherlands.
³ Department of Neurosurgery, St Vincent's Hospital Melbourne, Melbourne, VIC 3065, Australia.
⁴ Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield S10 2JF, UK.
⁵ Victor Horsley Department of Neurosurgery, National Hospital for Neurology & Neurosurgery, London WC1N 3BG, UK.
⁶ Department of Neurosurgery, Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield S10 2JF, UK.
⁷ Department of Orthopaedics, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK.
⁸ Welsh Centre for Spinal Surgery & Trauma, University hospital of Wales, Cardiff CF14 4XW, UK.
⁹ Spinal Surgery Unit, Royal National Orthopaedic Hospital, Stanmore HA7 4LP, UK.
¹⁰ Edinburgh Spinal Surgery Outcome Studies Group, Department of Neurosurgery, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK.
¹¹ Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, University College London Hospitals, London WC1N 3BG, UK.
¹² Royal Derby Spinal Centre, Royal Derby Hospital, Derby DE22 3NE, UK.
¹³ Nottingham Centre for Spinal Studies and Surgery, Queens Medical Centre, Nottingham University Hospitals, Nottingham NG7 2UH, UK.
¹⁴ Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India.
¹⁵ Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India.
¹⁶ Neurosciences Research Centre, Institute of Molecular and Clinical Sciences, St George's, University of London, London WC1E 7HU, UK.
¹⁷ Brighton and Sussex Medical School, South East Neurosurgery and South East Spinal Surgery, University Hospitals Sussex NHS Foundation Trust, Brighton BN1 9PX, UK.
¹⁸ Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, ON M5T 2S8, Canada.
¹⁹ Anne McLaren Laboratory for Regenerative Medicine, Welcome Trust MRC Cambridge Stem Cell Institute, University of Cambridge, Cambridge CB2 0PY, UK.

PMID: 34441949
PMCID: PMC8397218
DOI: 10.3390/jcm10163653

Review

The Relative Merits of Posterior Surgical Treatments for Multi-Level Degenerative Cervical Myelopathy Remain Uncertain: Findings from a Systematic Review

Xiaoyu Yang et al. J Clin Med. 2021.

. 2021 Aug 18;10(16):3653.

doi: 10.3390/jcm10163653.

Authors

Affiliations

¹ Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge CB0 0GG, UK.
² Department of Neurosurgery, Leiden University Medical Centre, 2333ZA Leiden, The Netherlands.
³ Department of Neurosurgery, St Vincent's Hospital Melbourne, Melbourne, VIC 3065, Australia.
⁴ Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield S10 2JF, UK.
⁵ Victor Horsley Department of Neurosurgery, National Hospital for Neurology & Neurosurgery, London WC1N 3BG, UK.
⁶ Department of Neurosurgery, Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield S10 2JF, UK.
⁷ Department of Orthopaedics, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK.
⁸ Welsh Centre for Spinal Surgery & Trauma, University hospital of Wales, Cardiff CF14 4XW, UK.
⁹ Spinal Surgery Unit, Royal National Orthopaedic Hospital, Stanmore HA7 4LP, UK.
¹⁰ Edinburgh Spinal Surgery Outcome Studies Group, Department of Neurosurgery, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK.
¹¹ Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, University College London Hospitals, London WC1N 3BG, UK.
¹² Royal Derby Spinal Centre, Royal Derby Hospital, Derby DE22 3NE, UK.
¹³ Nottingham Centre for Spinal Studies and Surgery, Queens Medical Centre, Nottingham University Hospitals, Nottingham NG7 2UH, UK.
¹⁴ Department of Orthopaedics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India.
¹⁵ Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India.
¹⁶ Neurosciences Research Centre, Institute of Molecular and Clinical Sciences, St George's, University of London, London WC1E 7HU, UK.
¹⁷ Brighton and Sussex Medical School, South East Neurosurgery and South East Spinal Surgery, University Hospitals Sussex NHS Foundation Trust, Brighton BN1 9PX, UK.
¹⁸ Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, ON M5T 2S8, Canada.
¹⁹ Anne McLaren Laboratory for Regenerative Medicine, Welcome Trust MRC Cambridge Stem Cell Institute, University of Cambridge, Cambridge CB2 0PY, UK.

PMID: 34441949
PMCID: PMC8397218
DOI: 10.3390/jcm10163653

Abstract

Objectives: To assess the reporting of study design and characteristics in multi-level degenerative cervical myelopathy (DCM) treated by posterior surgical approaches, and perform a comparison of clinical and radiographic outcomes between different approaches.

Methods: A literature search was performed in Embase and MEDLINE between 1995-2019 using a sensitive search string combination. Studies were selected by predefined selection criteria: Full text articles in English, with >10 patients (prospective) or >50 patients (retrospective), reporting outcomes of multi-level DCM treated by posterior surgical approach.

Results: A total of 75 studies involving 19,510 patients, conducted worldwide, were identified. Laminoplasty was described in 56 studies (75%), followed by laminectomy with (36%) and without fusion (16%). The majority of studies were conducted in Asia (84%), in the period of 2016-2019 (51%), of which laminoplasty was studied predominantly. Twelve (16%) prospective studies and 63 (84%) retrospective studies were identified. The vast majority of studies were conducted in a single centre (95%) with clear inclusion/exclusion criteria and explicit cause of DCM. Eleven studies (15%) included patients with ossification of the posterior longitudinal ligament exclusively with cohorts of 57 to 252. The clinical and radiographic outcomes were reported with heterogeneity when comparing laminoplasty, laminectomy with and without fusion.

Conclusions: Heterogeneity in the reporting of study and sample characteristics exists, as well as in clinical and radiographic outcomes, with a paucity of studies with a higher level of evidence. Future studies are needed to elucidate the clinical effectiveness of posterior surgical treatments.

Keywords: cervical spine; degenerative cervical myelopathy; fusion; laminectomy; laminoplasty; multi-level; myelopathy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

**Figure 1**
PRISMA flow diagram of search strategy.

**Figure 2**
Location (A) and trend (B) of published research.

See this image and copyright information in PMC

References

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The Relative Merits of Posterior Surgical Treatments for Multi-Level Degenerative Cervical Myelopathy Remain Uncertain: Findings from a Systematic Review

Affiliations

The Relative Merits of Posterior Surgical Treatments for Multi-Level Degenerative Cervical Myelopathy Remain Uncertain: Findings from a Systematic Review

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

LinkOut - more resources

Full Text Sources