Skip to main content
Log in

A prospective randomized trial comparing anterior cervical discectomy and fusion versus plate-only open-door laminoplasty for the treatment of spinal stenosis in degenerative diseases

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Objective

For three or more involved cervical levels, there is a debate over which approach yields the best outcomes for the treatment of multilevel cervical degenerative disease. Our objective is to compare the radiological and clinical outcomes of two treatments for multilevel cervical degenerative disease: anterior cervical discectomy and fusion (ACDF) versus plate-only open-door laminoplasty (laminoplasty).

Methods

Patients were randomized on a 1:1 randomization schedule with 17 patients in the ACDF group and 17 patients in the laminoplasty group. Clinical outcomes were assessed by a visual analog scale (VAS), Japanese Orthopedic Association (JOA) scores, operative time, blood loss, rates of complications, drainage volume, discharge days after surgery, and complications. The cervical spine curvature index (CI) and range of motion (ROM) were assessed with radiographs.

Results

The mean VAS score, the mean JOA score, and the rate of complications did not differ significantly between groups. The laminoplasty group had greater blood loss, a longer operative time, more drainage volume, and a longer hospital stay than the ACDF group. There were no significant differences in the CI and ROM between the two groups at baseline and at each follow-up time point. ROM in both groups decreased significantly after surgery.

Conclusions

Both ACDF and laminoplasty are effective and safe treatments for multilevel cervical degenerative disease. ACDF causes fewer traumas than laminoplasty.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Chong E, Mobbs RJ, Pelletier MH, Walsh WR (2016) Titanium/polyetheretherketone cages for cervical arthrodesis with degenerative and traumatic pathologies: early clinical outcomes and fusion rates. Orthop Surg. 8:19–26. doi:10.1111/os.12221

    Article  PubMed  Google Scholar 

  2. Feng YT, Hwang SL, Lin CL, Lee IC, Lee KT (2012) Safety and resource utilization of anterior cervical discectomy and fusion. Kaohsiung J Med Sci 28:495–499. doi:10.1016/j.kjms.2012.04.007

    Article  PubMed  Google Scholar 

  3. Ma WH, Yu L, Song XH, Xu RM, Hu Y, Zhao LJ, Sun SH, Jiang WY, Gu YJ (2013) Anterior transpedicular screw technique for failed anterior cervical internal fixation in revision surgery: a case report. Orthop Surg. 5:305–308. doi:10.1111/os.12067

    Article  PubMed  Google Scholar 

  4. Lei T, Shen Y, Wang LF, Cao JM, Ding WY, Ma QH (2012) Cerebrospinal fluid leakage during anterior approach cervical spine surgery for severe ossification of the posterior longitudinal ligament: prevention and treatment. Orthop Surg. 4:247–252. doi:10.1111/os.12007

    Article  PubMed  Google Scholar 

  5. Hirabayashi K, Bohlman HH (1995) Multilevel cervical spondylosis. Laminoplasty versus anterior decompression. Spine (Phila Pa 1976) 20:1732–1734

    Article  CAS  Google Scholar 

  6. Ren DJ, Li F, Zhang ZC, Kai G, Shan JL, Zhao GM, Sun TS (2015) Comparison of functional and radiological outcomes between two posterior approaches in the treatment of multilevel cervical spondylotic myelopathy. Chin Med J (Engl) 128:2054–2058. doi:10.4103/0366-6999.161363

    Article  Google Scholar 

  7. Lee SB, Cho KS, Kim JY, Yoo DS, Lee TG, Huh PW (2012) Hybrid surgery of multilevel cervical degenerative disc disease: review of literature and clinical results. J Korean Neurosurg Soc. 52:452–458. doi:10.3340/jkns.2012.52.5.452

    Article  PubMed  PubMed Central  Google Scholar 

  8. Nunley PD, Jawahar A, Kerr EJ 3rd, Cavanaugh DA, Howard C, Brandao SM (2009) Choice of plate may affect outcomes for single versus multilevel ACDF: results of a prospective randomized single-blind trial. Spine J. 9:121–127. doi:10.1016/j.spinee.2007.11.009

    Article  PubMed  Google Scholar 

  9. Quinn JC, Kiely PD, Lebl DR, Hughes AP (2015) Anterior surgical treatment of cervical spondylotic myelopathy: review article. HSS J. 11:15–25. doi:10.1007/s11420-014-9408-6

    Article  PubMed  Google Scholar 

  10. Song KJ, Song JS, Kim DY, Shim DG, Lee KB (2014) Efficacy of combined anteroposterior fusion with no plate versus anterior fusion alone with cage and plate for multilevel degenerative cervical disease. Spine J. 14:598–603. doi:10.1016/j.spinee.2013.06.082

    Article  PubMed  Google Scholar 

  11. Cho DY, Lee WY, Sheu PC (2004) Treatment of multilevel cervical fusion with cages. Surg Neurol 62:378–385

    Article  PubMed  Google Scholar 

  12. Sun Y, Li L, Zhao J, Gu R (2015) Comparison between anterior approaches and posterior approaches for the treatment of multilevel cervical spondylotic myelopathy: a meta-analysis. Clin Neurol Neurosurg 134:28–36. doi:10.1016/j.clineuro.2015.04.011

    Article  PubMed  Google Scholar 

  13. Park AE, Heller JG (2004) Cervical laminoplasty: use of a novel titanium plate to maintain canal expansion–surgical technique. J Spinal Disord Tech 17:265–271

    Article  PubMed  Google Scholar 

  14. Yang HL, Chen GD, Zhang HT, Wang L, Luo ZP (2013) Open-door laminoplasty with plate fixation at alternating levels for treatment of multilevel degenerative cervical disease. J Spinal Disord Tech 26:E13–E18. doi:10.1097/BSD.0b013e31827844cd

    Article  PubMed  Google Scholar 

  15. Kiely PD, Quinn JC, Du JY, Lebl DR (2015) Posterior surgical treatment of cervical spondylotic myelopathy: review article. HSS J 11:36–42. doi:10.1007/s11420-014-9425-5

    Article  PubMed  PubMed Central  Google Scholar 

  16. Cole T, Veeravagu A, Zhang M, Azad TD, Desai A, Ratliff JK (2015) Anterior versus posterior approach for multilevel degenerative cervical disease: a retrospective propensity score-matched study of the MarketScan database. Spine (Phila Pa 1976) 40:1033–1308. doi:10.1097/BRS.0000000000000872

    Article  Google Scholar 

  17. Witiw CD, Fehlings MG (2016) Degenerative cervical myelopathy. CMAJ. [Epub ahead of print] (No abstract available)

  18. Wen ZQ, Du JY, Ling ZH, Xu HD, Lin XJ (2015) Anterior cervical discectomy and fusion versus anterior cervical corpectomy and fusion in the treatment of multilevel cervical spondylotic myelopathy: systematic review and a meta-analysis. Ther Clin Risk Manag 11:161–170. doi:10.2147/TCRM.S72699.eCollection

    PubMed  PubMed Central  Google Scholar 

  19. Hwang SL, Lee KS, Su YF, Kuo TH, Lieu AS, Lin CL, Howng SL, Hwang YF (2007) Anterior corpectomy with iliac bone fusion or discectomy with interbody titanium cage fusion for multilevel cervical degenerated disc disease. J Spinal Disord Tech. 20:565–570

    Article  PubMed  Google Scholar 

  20. Fang Z, Tian R, Sun TW, Yadav SK, Hu W, Xie SQ (2016) Expansion open-door laminoplasty with foraminotomy versus anterior cervical discectomy and fusion for coexisting multilevel cervical myelopathy and unilateral radiculopathy. Clin Spine Surg. 29:E21–E27. doi:10.1097/BSD.0000000000000074

    PubMed  Google Scholar 

  21. Shamji MF, Mohanty C, Massicotte EM, Fehlings MG (2016) The Association of Cervical Spine Alignment with Neurologic Recovery in a Prospective Cohort of Patients with Surgical Myelopathy: analysis of a series of 124 cases. World Neurosurg. 86:112–119. doi:10.1016/j.wneu.2015.09.044 (Epub 2015 Sep 25)

    Article  PubMed  Google Scholar 

  22. Shamji MF, Cook C, Pietrobon R, Tackett S, Brown C, Isaacs RE (2009) Impact of surgical approach on complications and resource utilization of cervical spine fusion: a nationwide perspective to the surgical treatment of diffuse cervical spondylosis. Spine J. 9:31–38. doi:10.1016/j.spinee.2008.07.005

    Article  PubMed  Google Scholar 

  23. Lau D, Chou D, Mummaneni PV (2015) Two-level corpectomy versus three-level discectomy for cervical spondylotic myelopathy: a comparison of perioperative, radiographic, and clinical outcomes. J Neurosurg Spine 23:280–289. doi:10.3171/2014.12.SPINE14545

    Article  PubMed  Google Scholar 

  24. Nakashima H, Tetreault LA, Nagoshi N, Nouri A, Kopjar B, Arnold PM, Bartels R, Defino H, Kale S, Zhou Q, Fehlings MG (2016) Does age affect surgical outcomes in patients with degenerative cervical myelopathy? Results from the prospective multicenter AOSpine International study on 479 patients. J Neurol Neurosurg Psychiatry 87:734–740. doi:10.1136/jnnp-2015-311074 Epub 2015 Sep 29

    Article  PubMed  Google Scholar 

  25. Xiao SW, Jiang H, Yang LJ, Xiao ZM (2015) Anterior cervical discectomy versus corpectomy for multilevel cervical spondylotic myelopathy: a meta-analysis. Eur Spine J 24:31–39. doi:10.1007/s00586-014-3607-1

    Article  PubMed  Google Scholar 

  26. Lee CH, Lee J, Kang JD, Hyun SJ, Kim KJ, Jahng TA, Kim HJ (2015) Laminoplasty versus laminectomy and fusion for multilevel cervical myelopathy: a meta-analysis of clinical and radiological outcomes. J Neurosurg Spine 22:589–595. doi:10.3171/2014.10.SPINE1498

    Article  PubMed  Google Scholar 

  27. Sakai K, Yoshii T, Hirai T, Arai Y, Shinomiya K, Okawa A (2016) Impact of the surgical treatment for degenerative cervical myelopathy on the preoperative cervical sagittal balance: a review of prospective comparative cohort between anterior decompression with fusion and laminoplasty. Eur Spine J. [Epub ahead of print]

  28. Manzano GR, Casella G, Wang MY, Vanni S, Levi AD (2012) A prospective, randomized trial comparing expansile cervical laminoplasty and cervical laminectomy and fusion for multilevel cervical myelopathy. Neurosurgery 70:264–277. doi:10.1227/NEU.0b013e3182305669

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The study was funded by the following program: The National Natural Science Foundation of China (30970718) and National High Technology Research and Development Program of China (863 Program) (2015AA033703).

Author information

Authors and Affiliations

Authors

Corresponding authors

Correspondence to Jian-ming Huang or Jian Dong.

Ethics declarations

Conflict of interest

The authors have declared no competing interests.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jiang, Yq., Li, XL., Zhou, Xg. et al. A prospective randomized trial comparing anterior cervical discectomy and fusion versus plate-only open-door laminoplasty for the treatment of spinal stenosis in degenerative diseases. Eur Spine J 26, 1162–1172 (2017). https://doi.org/10.1007/s00586-016-4878-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-016-4878-5

Keywords

Navigation