PDF
ePub
Citation
Print
Abstract
Objectives
We wanted to compare the clinical and radiographic outcomes of laminoplasty and laminectomy & fusion to treat multilevel cervical spondylosis.
Summary of the Literature Review
Laminoplasty and laminectomy & fusion are being increasingly used to treat multilevel cervical spondylosis, but definitive guidelines have not yet been established.
Materials and Methods
Fifty eight patients who were followed up for more than a year and who were treated for multilevel cervical spondylosis with either laminoplasty or laminectomy & fusion between March 2000 and March 2009 were reviewed. Twenty eight patients who underwent laminectomy & fusion were matched with 30 patients who underwent laminoplasty.
Results
The laminoplasty group showed statistically significant improvements in the Japanese Orthopaedic Association (JOA) score and Visual analogue scale (VAS) score. The cervical lordosis for the preoperative and latest sagittal alignment in the laminoplasty group decreased from 14 degrees to 5 degrees and the cervical kyphosis in the laminectomy & fusion group increased from 10 degrees to 15 degrees with no statistically significant difference. However, 3 cases with less than 5 degrees of cervical lordosis in the laminoplasty group showed progression of kyphosis at the last follow-up.
Conclusion
The clinical outcomes of laminoplasty for multilevel cervical spondylosis were better than those of laminectomy & fusion. However, it is considered that additional study for laminectomy & fusion is needed to prevent the long-term progress of cervical kyphosis in cases with preoperatively decreased cervical lordosis of less than 5 degrees, though it is impossible to make such comparisons with the small number of cases in our study.
REFERENCES
1.Kim YT., Lee CS., Na HY., Cha YC. The treatment of cervical myelopathy. J Korean Spine Surg. 1998. 5:293–300.
2.Chang H., Bahk WJ., An JG., Choi KH. Pre and postoperative evaluation of cervical myelopathy using MR imaging. J Korean Spine Surg. 1994. 1:326–36.
3.Heller JG., Edwards CC., Murakami H., Rodts GE. Lami�o�las�y versus lami�ec�omy a�d fusio� for mul�ilevel cervical myelo�a�hy. Spine. 2001. 26:1330–6.
4.Bu�ler �C., Whi�ecloud TS III. Pos�lami�ec�omy ky�hosis: causes a�d surgical ma�ageme��. �r�ho� Cli� Nor�h Am. 1992. 23:505–11.
5.Cerisoli M., Ver�izzi E., Guilio�i M. Cervical s�i�e cha�ges followi�g lami�ec�omy: cli�ico-radiological s�udy. � Neurosurg Sci. 1980. 24:63–70.
6.Cybulski GR., D'A�gelo CM. Neurological de�eriora�io� af�er lami�ec�omy for s�o�dylo�ic cervical myeloradiculo�a�hy: �he �u�a�ive role of s�i�al cord ischaemia. � Neurol Neurosurg Psychia�ry. 1988. 51:717–8.
7.E�s�ei� NE. Lami�ec�omy wi�h �os�erior wiri�g a�d fusio� for cervical ossifica�io� of �he �os�erior lo�gi�udi�al ligame��, s�o�dylosis, ossifica�io� of �he yellow ligame��, s�e�osis, a�d i�s�abili�y: a s�udy of 5 �a�ie��s. � S�i�al Disord. 1999. 12:461–6.
8.Kumar VG., Rea GL., Mervis L�., McGregor �M. Cervical s�o�dylo�ic myelo�a�hy: fu�c�io�al a�d radiogra�hic lo�g-�erm ou�come af�er lami�ec�omy a�d �os�erior fusio�. Neurosurgery. 1999. 44:771–7.
9.Miyazaki K., Hirohuji E., ��o S, et al. Ex�e�sive simul�a�eous mul�isegme��al lami�ec�omy a�d �os�erior decom�ressio� wi�h �os�erola�eral fusio�. � ��� Res Soc. 1994. 5:167.
10.Hirabayashi K. Ex�a�sive o�e�-door lami�o�las�y for cervical s�o�dylo�ic myelo�a�hy. ��� � Surg. 1978. 32:1159–63.
11.Tomi�a K., Kawahara N., Toriba�ake Y., Heller �G. Ex�a�sive midli�e T-saw lami�o�las�y (modified s�i�ous �rocess-s�li��i�g) for �he ma�ageme�� of cervical myelo�a�hy. Spine. 1998. 23:32–7.
12.Maurer PK., Elle�boge� RG., Ecklu�d �., Simo�ds GR., va� Dam B., ��dra SL. Cervical s�o�dylo�ic myelo�a�hy: �rea�me�� wi�h �os�erior decom�ressio� a�d Luque rec�a�gle bo�e fusio�. Neurosurgery. 1991. 28:680–3.
13.Hirabayashi K., Sa�omi K. ��era�ive �rocedure a�d resul�s of ex�a�sive o�e�-door lami�o�las�y. ��� � Surg. 1988. 13:870–6.
14.Sa�omi K., Nishu Y., Koh�o T., Hirabayashi K. Lo�g-�erm follow-u� s�udies of o�e�-door ex�a�sive lami�o�las�y for cervical s�e�o�ic myelo�a�hy. Spine. 1994. 19:507–10.
15.Yo�e�obu K., Hoso�o N., Iwasaki M., Asa�o M., ��o K. Lami�o�las�y versus sub�o�al cor�ec�omy: a com�ara�ive s�udy of resul�s i� mul�isegme��al cervical s�o�dylo�ic myelo�a�hy. Spine. 1992. 17:1281–4.
16.Hirabayashi K., Miyakawa �., Sa�omi K., Maruyama T., Waka�o K. ��era�ive resul�s a�d �os�o�era�ive �rogressio� of ossifica�io� amo�g �a�ie��s wi�h ossifica�io� of cervical �os�erior lo�gi�udi�al ligame��. Spine. 1981. 6:354–64.
17.Boles�a M�., Rech�i�e GR., Chri� AM. Three, four-level a��erior cervical discec�omy a�d fusio� wi�h �la�e fixa�io�: a �ros�ec�ive s�udy. Spine. 2000. 25:2040–4.
18.Emery SE., Fisher �R., Bohlma� HH. Three-level a��erior cervical discec�omy a�d fusio�: radiogra�hic a�d cli�ical resul�s. Spine. 1997. 22:2622–4.
19.Sau�ders RL., Pikus H�., Ball P. Four-level cervical cor�ec�omy. Spine. 1998. 23:2455–61.
20.Ebersold M�., Pare MC., Quas� LM. Surgical �rea�me�� for cervical s�o�dylo�ic myelo�a�hy. � Neurosurg. 1995. 82:745–51.
21.Fehli�gs MG., Coo�er PR., Errico T�. Pos�erior �la�es i� �he ma�ageme�� of cervical i�s�abili�y: lo�g-�erm resul�s i� 44 �a�ie��s. � Neurosurg. 1994. 81:341–9.
22.Ishida Y., Suzuki K., �hmori K., Kika�a Y., Ha��ori Y. Cri�ical a�alysis of ex�e�sive cervical lami�ec�omy. Neurosurgery. 1989. 24:215–22.
23.Herkowi�z HN. A com�ariso� of a��erior cervical fusio�, cervical lami�ec�omy, a�d cervical lami�o�las�y for �he surgical ma�ageme�� of mul�i�le level s�o�dylo�ic radiculo�a�hy. Spine. 1988. 13:774–80.
24.Dai L., Ni B., Yua� W., �ia L. Radiculo�a�hy af�er lami�ec�omy for cervical com�ressio� myelo�a�hy. � Bo�e �oi�� Surg Br. 1998. 80:846–9.
25.Guigui P., Be�ois� M., Deburge A. S�i�al deformi�y a�d i�s�abili�y af�er mul�ilevel cervical lami�ec�omy for s�o�dylo�ic myelo�a�hy. Spine. 1997. 23:440–7.
26.Suk KS., Kim KT., Lee SH, et al. Cha�ges of Ra�ge of Mo- �io� a�d Sagi��al Alig�me�� of �he Cervical Spine af�er Lami�o�las�y. � Korea� Spine Surg. 2005. 12:247–54.
Fig. 1
59-year-old woman with posterior decompression C3-4 & instrumented PLF for spinal stenosis C3-4, 4-5, 5-6 (A) Preoperative X-ray showing 8.9’ of cervical kyphosis (B) Postoperative X-ray showing 17.7’ of cervical kyphosis.
Table 1.
Comparison of data between group A and group B
| Parameters | ∗ Group A | ∗∗ Group B |
|---|---|---|
| No. of cases | 30 | 28 |
| Mean age (years) | 52.4(34-76) | 58.6(39-78) |
| Gender (M:F) | 18:12 | 19:9 |
| Duration of symptoms (months) | 17.2(3-54) | 19.6(4-36) |
| Levels | 3.2(3-4) | 3.8(3-5) |
| Follow-up (months) | 26.2(12-46) | 25.6(9-62) |
Table 2.
Postoperative results between group A and group B
| Parameters | ∗ Group A | ∗∗ Group B | P-value |
|---|---|---|---|
| Operating room time (min) | 102(79-131) | 153(128-172) | 0.021 |
| Estimated blood loss (mL) | 273(124-369) | 366(285-422) | 0.028 |
| JOA score (mean improve.) | 4.9(0-7) | 3.3(0-5) | 0.019 |
| Preoperative | 6.9(3-10) | 6.1(2-10) | |
| Latest | 11.8(7-14) | 9.4(5-13) | |
| VAS score (mean improve.) | 6.1(3-9) | 4.0(0-9) | 0.017 |
| Preoperative | 7.3(4-10) | 6.7(5-9) | |
| Latest | 1.2(0-5) | 2.7(0-8) |
Table 3.
Changes in sagittal alignment of suprajacent, decompressed, and subjacent levels
| Level | ∗ Group A | ∗∗ Group B | P-value |
|---|---|---|---|
| Suprajacent level | 0.091 | ||
| Preoperative | 0 | 3K | |
| Latest | 1L | 2K | |
| Decompressed level | 0.085 | ||
| Preoperative | 12L | 5K | |
| Latest | 7L | 5K | |
| Subjacent level | 0.089 | ||
| Preoperative | 2L | 2K | |
| Latest | 3K | 8K | |
| Whole level | 14L ⇀ 5L | 10K ⇀ 15K | 0.088 |
XML Download