title: Laminoplasty versus laminectomy and fusion for multilevel cervical myelopathy: a meta-analysis of clinical and radiological outcomes.
abstract: OBJECT Posterior cervical surgery, expansive laminoplasty (EL) or laminectomy followed by fusion (LF), is usually performed in patients with multilevel (≥ 3) cervical spondylotic myelopathy (CSM). However, the superiority of either of these techniques is still open to debate. The aim of this study was to compare clinical outcomes and postoperative kyphosis in patients undergoing EL versus LF by performing a meta-analysis. METHODS Included in the meta-analysis were all studies of EL versus LF in adults with multilevel CSM in MEDLINE (PubMed), EMBASE, and the Cochrane library. A random-effects model was applied to pool data using the mean difference (MD) for continuous outcomes, such as the Japanese Orthopaedic Association (JOA) grade, the cervical curvature index (CCI), and the visual analog scale (VAS) score for neck pain. RESULTS Seven studies comprising 302 and 290 patients treated with EL and LF, respectively, were included in the final analyses. Both treatment groups showed slight cervical lordosis and moderate neck pain in the baseline state. Both groups were similarly improved in JOA grade (MD 0.09, 95% CI -0.37 to 0.54, p = 0.07) and neck pain VAS score (MD -0.33, 95% CI -1.50 to 0.84, p = 0.58). Both groups evenly lost cervical lordosis. In the LF group lordosis seemed to be preserved in long-term follow-up studies, although the difference between the 2 treatment groups was not statistically significant. CONCLUSIONS Both EL and LF lead to clinical improvement and loss of lordosis evenly. There is no evidence to support EL over LF in the treatment of multilevel CSM. Any superiority between EL and LF remains in question, although the LF group shows favorable long-term results.
authors: 1Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam;|2Department of Neurosurgery, Konyang University Hospital, Konyang University College of Medicine, Daejeon;
authors: Chang-Hyun
authors: CH
authors: Lee
authors: 3Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; and.
authors: Jaebong
authors: J
authors: Lee
authors: 4Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors: James D
authors: JD
authors: Kang
authors: 1Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam;
authors: Seung-Jae
authors: SJ
authors: Hyun
authors: 1Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam;
authors: Ki-Jeong
authors: KJ
authors: Kim
authors: 1Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam;
authors: Tae-Ahn
authors: TA
authors: Jahng
authors: 1Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam;
authors: Hyun-Jib
authors: HJ
authors: Kim
mesh_terms: D066193:Cervical Cord / Q000601:surgery*; D006801:Humans; D007796:Laminectomy / Q000379:methods; D065406:Laminoplasty / Q000379:methods; D013118:Spinal Cord Diseases / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods; D016896:Treatment Outcome
keywords: CCI = cervical curvature index; CSM = cervical spondylotic myelopathy; EL = expansive laminoplasty; JOA = Japanese Orthopaedic Association; LF = laminectomy followed by fusion; MD = mean difference; VAS = visual analog scale; cervical; comparison; fusion; laminectomy; laminoplasty; meta-analysis; myelopathy