Laminectomy and fusion versus laminoplasty for the treatment of degenerative cervical myelopathy: results from the AOSpine North America and International prospective multicenter studies.
It remains unclear whether cervical laminoplasty (LP) offers advantages over cervical laminectomy and fusion (LF) in patients undergoing posterior decompression for degenerative cervical myelopathy (DCM).



The objective of this study is to compare outcomes of LP and LF.



This is a multicenter international prospective cohort study.



A total of 266 surgically treated symptomatic DCM patients undergoing cervical decompression using LP (N=100) or LF (N=166) were included.



The outcome measures were the modified Japanese Orthopaedic Association score (mJOA), Nurick grade, Neck Disability Index (NDI), Short-Form 36v2 (SF36v2), length of hospital stay, length of stay in the intensive care unit, treatment complications, and reoperations.



Differences in outcomes between the LP and LF groups were analyzed by analysis of variance and analysis of covariance. The dependent variable in all analyses was the change score between baseline and 24-month follow-up, and the independent variable was surgical procedure (LP or LF). In the analysis of covariance, outcomes were compared between cohorts while adjusting for gender, age, smoking, number of operative levels, duration of symptoms, geographic region, and baseline scores.



There were no differences in age, gender, smoking status, number of operated levels, and baseline Nurick, NDI, and SF36v2 scores between the LP and LF groups. Preoperative mJOA was lower in the LP compared with the LF group (11.52±2.77 and 12.30±2.85, respectively, p=.0297). Patients in both groups showed significant improvements in mJOA, Nurick grade, NDI, and SF36v2 physical and mental health component scores 24 months after surgery (p<.0001). At 24 months, mJOA scores improved by 3.49 (95% confidence interval [CI]: 2.84, 4.13) in the LP group compared with 2.39 (95% CI: 1.91, 2.86) in the LF group (p=.0069). Nurick grades improved by 1.57 (95% CI: 1.23, 1.90) in the LP group and 1.18 (95% CI: 0.92, 1.44) in the LF group (p=.0770). There were no differences between the groups with respect to NDI and SF36v2 outcomes. After adjustment for preoperative characteristics, surgical factors and geographic region, the differences in mJOA between surgical groups were no longer significant. The rate of treatment-related complications in the LF group was 28.31% compared with 21.00% in the LP group (p=.1079).



Both LP and LF are effective at improving clinical disease severity, functional status, and quality of life in patients with DCM. In an unadjusted analysis, patients treated with LP achieved greater improvements on the mJOA at 24-month follow-up than those who received LF; however, these differences were insignificant following adjustment for relevant confounders.
Department of Surgery, University of Toronto, Stewart Building 149 College Street, 5th Floor, Toronto, Ontario M5T 1P5, Canada. Electronic address: michael.fehlings@uhn.ca.
Michael G
MG
Fehlings
Department of Surgery, Toronto Western Hospital, 399 Bathurst St, Toronto, Ontario M5T 2S8, Canada.
Carlo
C
Santaguida
Department of Surgery, Toronto Western Hospital, 399 Bathurst St, Toronto, Ontario M5T 2S8, Canada.
Lindsay
L
Tetreault
Department of Neurosurgery, University of Kansas, 3901 Rainbow Blvd Mail Stop 3021, Kansas City, KS 66160, USA.
Paul
P
Arnold
Department of Neurosurgery, University Hospital Catania, P.zza Università, 2, I - 95124 Catania, Italy.
Giuseppe
G
Barbagallo
Faculty of Medicine, University of Sao Paulo, Avenida Doutor Arnaldo, 455 - Cerqueira César, São Paulo - SP 01246-904, Brazil.
Helton
H
Defino
Department of Neurosurgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
Shashank
S
Kale
Department of Orthopedics, Third Military Medical University, No. 30 Gaotanyan St, Chongqing 400038, China.
Qiang
Q
Zhou
Orthopaedics & Spine Center, Emory University Hospital, 59 Executive Park South, Atlanta, GA 30329, USA.
Tim S
TS
Yoon
Department of Health Services, Magnuson Health Sciences Center, Room H-680, Box 357660, 1959 NE Pacific St, Seattle, WA 98195-7660, USA.
Branko
B
Kopjar
D000328:Adult; D005260:Female; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000601:surgery*; D007796:Laminectomy / Q000009:adverse effects* / Q000592:standards; D065406:Laminoplasty / Q000009:adverse effects* / Q000592:standards; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009656:North America; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D011788:Quality of Life
Decompression/surgical; Efficacy/treatment; Laminectomy; Laminoplasty; Myelopathy/compressive; Outcome/treatment