Abstract
Background
Surgical approaches for multi-level cervical spondylotic myelopathy (CSM) include posterior cervical surgery via laminectomy and fusion (LF) or expansive laminoplasty (EL). The relative benefits and risks of either approach in terms of clinical outcomes and complications are not well established. A systematic review and meta-analysis was conducted to address this topic.
Methods
Electronic searches were performed using six databases from their inception to January 2016, identifying all relevant randomized controlled trials (RCTs) and non-RCTs comparing LF vs EL for multi-level cervical myelopathy. Data was extracted and analyzed according to predefined endpoints.
Results
From 10 included studies, there were 335 patients who underwent LF compared to 320 patients who underwent EL. There was no significant difference found postoperatively between LF and EL groups in terms of postoperative JOA (P = 0.39), VAS neck pain (P = 0.93), postoperative CCI (P = 0.32) and Nurich grade (P = 0.42). The total complication rate was higher for LF compared to EL (26.4 vs 15.4 %, RR 1.77, 95 % CI 1.10, 2.85, I 2 = 34 %, P = 0.02). Reoperation rate was found to be similar between LF and EL groups (P = 0.52). A significantly higher pooled rate of nerve palsies was found in the LF group compared to EL (9.9 vs 3.7 %, RR 2.76, P = 0.03). No significant difference was found in terms of operative time and intraoperative blood loss.
Conclusions
From the available low-quality evidence, LF and EL approaches for CSM demonstrates similar clinical improvement and loss of lordosis. However, a higher complication rate was found in LF group, including significantly higher nerve palsy complications. This requires further validation and investigation in larger sample-size prospective and randomized studies.
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References
Broughton E (2015) Cervical spondylotic myelopathy. In: Challenging concepts in neurosurgery: cases with expert commentary. Oxford University Press
Liu Y, Hou Y, Yang L et al (2012) Comparison of 3 reconstructive techniques in the surgical management of multilevel cervical spondylotic myelopathy. Spine 37:E1450–E1458
Rao RD, Gourab K, David KS (2006) Operative treatment of cervical spondylotic myelopathy. J Bone Joint Surg Am 88:1619–1640
Kawakami M, Tamaki T, Iwasaki H et al (2000) A comparative study of surgical approaches for cervical compressive myelopathy. Clin Orthop Relat Res 381:129–136
Highsmith JM, Dhall SS, Haid RW Jr et al (2011) Treatment of cervical stenotic myelopathy: a cost and outcome comparison of laminoplasty vs laminectomy and lateral mass fusion: clinical article. J Neurosurg Spine 14:619–625
Guigui P, Benoist M, Deburge A (1998) Spinal deformity and instability after multilevel cervical laminectomy for spondylotic myelopathy. Spine 23:440–447
Guigui P, Lefevre C, Lassale B (1998) et al Static and dynamic changes of the cervical spine after laminectomy for cervical spondylotic myelopathy. Rev Chir Orthop Reparatrice Appar Mot 84:17–25
Kumar VGR, Rea GL, Mervis LJ et al (1999) Cervical spondylotic myelopathy: functional and radiographic long-term outcome after laminectomy and posterior fusion. Neurosurgery 44:771–777
Heller JG, Edwards CC, Murakami H et al (2001) Laminoplasty vs laminectomy and fusion for multilevel cervical myelopathy: an independent matched cohort analysis. Spine 26:1330–1336
Moher D, Liberati A, Tetzlaff J et al (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e1000097
Phan K, Mobbs RJ (2015) Systematic reviews and meta-analyses in spine surgery, neurosurgery and orthopedics: guidelines for the surgeon scientist. J Spine Surg 1:19–27
Furlan AD, Pennick V, Bombardier C et al (2009) Updated method guidelines for systematic reviews in the Cochrane Back Review Group. Spine (Phila Pa 1976) 34:1929–1941
Cowley DE (1995) Prostheses for primary total hip replacement. A critical appraisal of the literature. Int J Technol Assess Health Care 11:770–778
Chen Y, Liu X, Chen D et al (2012) Surgical strategy for ossification of the posterior longitudinal ligament in the cervical spine. Orthopedics (Online) 35:e1231
Du W, Wang L, Shen Y et al (2013) Long-term impacts of different posterior operations on curvature, neurological recovery and axial symptoms for multilevel cervical degenerative myelopathy. Eur Spine J 22:1594–1602
Lee CH, Jahng TA, Hyun SJ et al (2014) Expansive laminoplasty vs laminectomy alone vs laminectomy and fusion for cervical ossification of the posterior longitudinal ligament: is there a difference in the clinical outcome and sagittal alignment? J Spinal Disord Tech 29:E9–E15
Manzano GR, Casella G, Wang MY et al (2012) A prospective, randomized trial comparing expansile cervical laminoplasty and cervical laminectomy and fusion for multilevel cervical myelopathy. Neurosurgery 70:264–277
Ren DJ, Li F, Zhang ZC et al (2015) Comparison of functional and radiological outcomes between two posterior approaches in the treatment of multilevel cervical spondylotic myelopathy. Chin Med J 128:2054–2058
Sivaraman A, Bhadra AK, Altaf F et al (2010) Skip laminectomy and laminoplasty for cervical spondylotic myelopathy: a prospective study of clinical and radiologic outcomes. J Spinal Disord Tech 23:96–100
Woods BI, Hohl J, Lee J et al (2011) Laminoplasty vs laminectomy and fusion for multilevel cervical spondylotic myelopathy. Clin Orthop Relat Res 469:688–695
Yang L, Gu Y, Shi J et al (2013) Modified plate-only open-door laminoplasty vs laminectomy and fusion for the treatment of cervical stenotic myelopathy. Orthopedics 36:e79–e87
Yukawa Y, Kato F, Ito K et al (2007) Laminoplasty and skip laminectomy for cervical compressive myelopathy: range of motion, postoperative neck pain, and surgical outcomes in a randomized prospective study. Spine 32:1980–1985
Lee CH, Lee J, Kang JD et al (2015) Laminoplasty vs laminectomy and fusion for multilevel cervical myelopathy: a meta-analysis of clinical and radiological outcomes. J Neurosurg Spine 22:589–595
Phan K, Mobbs RJ (2016) Minimally invasive vs open laminectomy for lumbar stenosis: a systematic review and meta-analysis. Spine (Phila Pa 1976) 41:E91–E100
Geck MJ, Eismont FJ (2002) Surgical options for the treatment of cervical spondylotic myelopathy. Orthop Clin North Am 33:329–348
Cusick JF, Pintar FA, Yoganandan N (1995) Biomechanical alterations induced by multilevel cervical laminectomy. Spine (Phila Pa 1976) 20:2392–2398 (discussion 8–9)
Baisden J, Voo LM, Cusick JF et al (1999) Evaluation of cervical laminectomy and laminoplasty: A longitudinal study in the goat model. Spine (Phila Pa 1976) 24:1283–1288 (discussion 8–9)
Mayfield FH (1976) Complications of laminectomy. Clin Neurosurg 23:435–439
Yonenobu K, Hosono N, Iwasaki M et al (1991) Neurologic complications of surgery for cervical compression myelopathy. Spine (Phila Pa 1976) 16:1277–1282
Kato Y, Iwasaki M, Fuji T et al (1998) Long-term follow-up results of laminectomy for cervical myelopathy caused by ossification of the posterior longitudinal ligament. J Neurosurg 89:217–223
Heller JG, Silcox DH 3rd, Sutterlin CE 3rd (1995) Complications of posterior cervical plating. Spine (Phila Pa 1976) 20:2442–2448
Pal GP, Routal RV (1996) The role of the vertebral laminae in the stability of the cervical spine. J Anat 188(Pt 2):485–489
Braly BA, Lunardini D, Cornett C et al (2012) Operative treatment of cervical myelopathy: cervical laminoplasty. Adv Orthop 2012:508534
Sodeyama T, Goto S, Mochizuki M et al (1999) Effect of decompression enlargement laminoplasty for posterior shifting of the spinal cord. Spine (Phila Pa 1976) 24:1527–1531 (discussion 31–2)
Kurakawa T, Miyamoto H, Kaneyama S, et al (2016) C5 nerve palsy after posterior reconstruction surgery: predictive risk factors of the incidence and critical range of correction for kyphosis. Eur spine J ( Epub ahead of print)
Koda M, Mochizuki M, Konishi H, et al (2016) Comparison of clinical outcomes between laminoplasty, posterior decompression with instrumented fusion, and anterior decompression with fusion for K-line (–) cervical ossification of the posterior longitudinal ligament. Eur spine J ( Epub ahead of print)
Kato S, Fehlings M (2016) Degenerative cervical myelopathy. Curr Rev Musculoskelet Med ( Epub ahead of print)
Sakaura H, Miwa T, Kuroda Y et al (2016) Incidence and risk factors for late neurologic deterioration after C3–C6 laminoplasty for cervical spondylotic myelopathy. Glob Spine J 6:53–59
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Phan, K., Scherman, D.B., Xu, J. et al. Laminectomy and fusion vs laminoplasty for multi-level cervical myelopathy: a systematic review and meta-analysis. Eur Spine J 26, 94–103 (2017). https://doi.org/10.1007/s00586-016-4671-5
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DOI: https://doi.org/10.1007/s00586-016-4671-5