COMPARISON OF EFFECTIVENESS BETWEEN LAMINOPLASTY AND LAMINECTOMY DECOMPRESSION AND FUSION WITH INTERNAL FIXATION FOR CERVICAL SPONDYLOTIC MYELOPATHY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Hang , SUN Tianwei , LU Shouliang , LI Qingjiang , Sandip Kumar Yadav.

Department of Spinal Surgery, Tianjin Union Medicine Centre, School of Clinical Medicine, Tianjin Medical University, Tianjin, 300070, P.R.China. Corresponding author: SUN Tianwei, E-mail: billsuntw@163.com;

Corresponding author：

Keywords：

Cervical spondylotic myelopathy; Laminoplasty; Laminectomy decompression and fusion; Axial symptom

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ObjectiveTo compare the clinical and radiographic outcomes between laminoplasty and laminectomy compression and fusion with internal fixation to treat cervical spondylotic myelopathy. MethodsBetween September 2006 and September 2009, 143 cases of multilevel cervical myelopathy (the affected segments were more than 3) were treated by laminoplasty in 87 cases (group A) and by laminectomy decompression and fusion with lateral mass screw fixation in 56 cases (group B). There was no significant difference in gender, age, disease duration, pathological type, and affected segments between 2 groups (P gt; 0.05). The operation time, intraoperative blood loss, improvement of neurological function [Japanese Orthopaedic Association (JOA) 17 score], and the incidences of complications were observed; the cervical curvature index (CCI), range of motion (ROM), and symptoms of neck and shoulder pain [visual analogue scale (VAS) and neck disability index (NDI) scores] were recorded and compared. ResultsThere was no significant difference in operation time and intraoperative blood loss between 2 groups (P gt; 0.05). All patients were followed up 18-30 months (mean, 24 months). C5 nerve root palsy occurred in 4 cases (4.60%) of group A and in 5 cases (8.93%) of group B, showing no significant difference (χ2=0.475, P=0.482). No complication of deep infection, pseudarthrosis, or screw loosening occurred. No closure of opened laminae was observed in group A; and no screw extrusion, breakage, or nerve injury was observed in group B. At last follow-up, neck axial symptoms appeared in 35 cases (40.23%) of group A and in 11 cases (19.64%) of group B, showing significant difference (χ2=6.612, P=0.009). No significant difference was found in JOA score, CCI, ROM, or VAS scores between 2 groups at preoperation (P gt; 0.05); the JOA score, ROM, and VAS scores of groups A and B and CCI of group A at last follow-up were significantly improved when compared with preoperative ones (P lt; 0.05). No significant difference was found in the JOA score, improvement rate, and VAS score between 2 groups (P gt; 0.05); however, significant differences were found in ROM and CCI between 2 groups (P lt; 0.05). There were significant differences (P lt; 0.05) in pain intensity, lifting, work, reaction, driving, and total score between 2 groups at last follow-up. ConclusionLaminectomy decompression and fusion with internal fixation can effectively relieve pain, but it will greatly reduce the ROM; laminoplasty has less complications and satisfactory outcome. The two methods have similar effectiveness in the improvement of neurological function.

Citation： ZHANG Hang,SUN Tianwei,LU Shouliang,LI Qingjiang,Sandip Kumar Yadav.. COMPARISON OF EFFECTIVENESS BETWEEN LAMINOPLASTY AND LAMINECTOMY DECOMPRESSION AND FUSION WITH INTERNAL FIXATION FOR CERVICAL SPONDYLOTIC MYELOPATHY. Chinese Journal of Reparative and Reconstructive Surgery, 2012, 26(10): 1191-1196. doi: Copy

1.	Houten JK, Cooper PR. Laminectomy and posterior cervical plating for multilevel cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament: effects on cervical alignment, spinal cord compression, and neurological outcome. Neurosurgery, 2003, 52(5): 1081-1088.
2.	Heller JG, Edwards CC II, Murakami H, et al. Laminoplasty versus laminectomy and fusion for multilevel cervical myelopathy: an independent matched cohort analysis. Spine (Phila Pa 1976), 2001, 26(12): 1330-1336.
3.	Highsmith JM, Dhall SS, Haid RW Jr, et al. Treatment of cervical stenotic myelopathy: a cost and outcome comparison of laminoplasty versus laminectomy and lateral mass fusion. J Neurosurg Spine, 2011, 14(5): 619-625.
4.	Manzano GR, Casella G, Wang MY, et al. A prospective, randomized trial comparing expansile cervical laminoplasty and cervical laminectomy and fusion for multilevel cervical myelopathy. Neurosurgery, 2012, 70(2): 264-277.
5.	孙天威, 张杭, 卢守亮, 等. 颈椎单开门椎管扩大椎板成形术后铰链侧C5神经根麻痹与不同椎板开门角度的临床分析. 中国修复重建外科杂志, 2011, 25(11): 1285-1289.
6.	Magerl F, Seemann PS. Stable posterior fusion of the atlas and axis by transarticular screw fixation//Kehr P, Weidner A. Cervical Spine. New York: Springer-Verlag, 1987: 322-327.
7.	Takeshita K, Murakami M, Kobayashi A, et al. Relationship between cervical curvature index (Ishihara) and cervical spine angle (C2-7). J Orthop Sci, 2001, 6(3): 223-236.
8.	Barrett I, Justin H, Joon L, et al. Laminoplasty versus laminectomy and fusion for multilevel cervical spondylotic myelopathy. Clin Orthop Relat Res, 2011, 469(3): 688-695.
9.	Chiba K, Ogawa Y, Ishii K, et al. Long-term results of expansive open-door laminoplasty for cervical myelopathy—average 14-year follow-up study. Spine (Phila Pa 1976), 2006, 31(26): 2998-3005.
10.	Mitsunage LK, Klineberg EO, Gupta MC. Laminoplasty techniques for the treatment of multilevel cervical stenosis. Adv Orthop, 2012, 2012: 307916.
11.	Iwasaki M, Okuda SY, Miyauchi A, et al. Surgical strategy for cervical myelopathy due to ossification of the posterior longitudinal ligament: Part 1: Clinical results and limitations of laminoplasty. Spine (Phila Pa 1976), 2007, 32(6): 647-653.
12.	Yamazaki A, Homma T, Uchiyama S, et al. Morphologic limitations of posterior decompression by midsagittal splitting method for myelopathy caused by ossification of the posterior longitudinal ligament in the cervical spine. Spine (Phila Pa 1976), 1999, 24(1): 32-34.
13.	Hatta Y, Shiraishi T, Hase H, et al. Is posterior spinal cord shifting by extensive posterior decompression clinically significant for multisegmental cervical spondylotic myelopathy? Spine (Phila Pa 1976), 2005, 30(21): 2414-2419.
14.	Sakaura H, Hosono N, Mukai Y, et al. Long-term outcome of laminoplasty for cervical myelopathy due to disc herniation: a comparative study of laminoplasty and anterior spinal fusion. Spine (Phila Pa 1976), 2005, 30(7): 756-759.
15.	Hosono N, Sakaura H, Mukai Y, et al. The source of axial pain after cervical laminoplasty-C7 is more crucial than deep extensor muscles. Spine (Phila Pa 1976), 2007, 32(26): 2985-2988.
16.	Roy-Camile R, Saillant G, Mazel C. Internal fixation of the unstable cervical spine by a posterior osteosynthesis with plate and screw//Cervical Spine Research Society. The Cervical Spine. 2nd ed. Philadelphia Pa: JB Lippincott, 1989: 390-403.
17.	Coe JD, Warden KE, Sutterlin CE, et al. Biomechanical evaluation of cervical spinal stabilization methods in a human cadaveric model. Spine (Phila Pa 1976), 1989, 14(10): 1122-1131.
18.	Nassr A, Eck JC, Ponnappan RK, et al. The incidence of C5 Palsy after multilevel cervical decompression procedures: A review of 750 consecutive cases. Spine (Phila Pa 1976), 2012, 37(3): 174-178.
19.	Imagama S, Matsuyama Y, Yukawa Y, et al. C5 palsy after cervical laminoplasty: a multicentre study. J Bone Joint Surg (Br), 2010, 92(3): 393-400.
20.	Kaiser MG , Mummaneni PV, Matz PG, et al. Radiographic assessment of cervical subaxial fusion. J Neurosurg Spine, 2009, 11(2): 221-227.
21.	阮狄克. 颈椎融合加速相邻节段退变: 真实还是虚构？中国脊柱脊髓杂志, 2011, 21(1): 6-7.
22.	王义生. 脊柱融合术与非融合术不是相互替代而是互补？中国脊柱脊髓杂志, 2011, 21(1): 7-8.
23.	Wang MY, Green BA, Vitarbo E, et al. Adjacent segment disease: an uncommon complication after cervical expansile laminoplasty: case report. Neurosurgery, 2003, 53(3): 770-773.
24.	Huang RC, Girardi FP, Poynton AR, et al. Treatment of multilevel cervical spondylotic myeloradiculopathy with posterior decompression and fusion with lateral mass plate fixation and local bone graft. J Spinal Disord Tech, 2003, 16(2): 123-129.
25.	Takeuchi K, Yokoyama T, Aburakawa S, et al. Axial symptoms after cervical laminoplasty with C3 laminectomy compared with conventional C3-C7 laminoplasty: a modified laminoplasty preserving the semispinalis cervicis inserted into axis. Spine (Phila Pa 1976), 2005, 30(22): 2544-2549.
26.	Takeuchi K, Yokoyama T, Ono A, et al. Cervical range of motion and alignment after laminoplasty preserving or reattaching the semispinalis cervicis inserted into axis. J Spinal Disord Tech, 2007, 20(8): 571-576.

1. Houten JK, Cooper PR. Laminectomy and posterior cervical plating for multilevel cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament: effects on cervical alignment, spinal cord compression, and neurological outcome. Neurosurgery, 2003, 52(5): 1081-1088.
2. Heller JG, Edwards CC II, Murakami H, et al. Laminoplasty versus laminectomy and fusion for multilevel cervical myelopathy: an independent matched cohort analysis. Spine (Phila Pa 1976), 2001, 26(12): 1330-1336.
3. Highsmith JM, Dhall SS, Haid RW Jr, et al. Treatment of cervical stenotic myelopathy: a cost and outcome comparison of laminoplasty versus laminectomy and lateral mass fusion. J Neurosurg Spine, 2011, 14(5): 619-625.
4. Manzano GR, Casella G, Wang MY, et al. A prospective, randomized trial comparing expansile cervical laminoplasty and cervical laminectomy and fusion for multilevel cervical myelopathy. Neurosurgery, 2012, 70(2): 264-277.
5. 孙天威, 张杭, 卢守亮, 等. 颈椎单开门椎管扩大椎板成形术后铰链侧C5神经根麻痹与不同椎板开门角度的临床分析. 中国修复重建外科杂志, 2011, 25(11): 1285-1289.
6. Magerl F, Seemann PS. Stable posterior fusion of the atlas and axis by transarticular screw fixation//Kehr P, Weidner A. Cervical Spine. New York: Springer-Verlag, 1987: 322-327.
7. Takeshita K, Murakami M, Kobayashi A, et al. Relationship between cervical curvature index (Ishihara) and cervical spine angle (C2-7). J Orthop Sci, 2001, 6(3): 223-236.
8. Barrett I, Justin H, Joon L, et al. Laminoplasty versus laminectomy and fusion for multilevel cervical spondylotic myelopathy. Clin Orthop Relat Res, 2011, 469(3): 688-695.
9. Chiba K, Ogawa Y, Ishii K, et al. Long-term results of expansive open-door laminoplasty for cervical myelopathy—average 14-year follow-up study. Spine (Phila Pa 1976), 2006, 31(26): 2998-3005.
10. Mitsunage LK, Klineberg EO, Gupta MC. Laminoplasty techniques for the treatment of multilevel cervical stenosis. Adv Orthop, 2012, 2012: 307916.
11. Iwasaki M, Okuda SY, Miyauchi A, et al. Surgical strategy for cervical myelopathy due to ossification of the posterior longitudinal ligament: Part 1: Clinical results and limitations of laminoplasty. Spine (Phila Pa 1976), 2007, 32(6): 647-653.
12. Yamazaki A, Homma T, Uchiyama S, et al. Morphologic limitations of posterior decompression by midsagittal splitting method for myelopathy caused by ossification of the posterior longitudinal ligament in the cervical spine. Spine (Phila Pa 1976), 1999, 24(1): 32-34.
13. Hatta Y, Shiraishi T, Hase H, et al. Is posterior spinal cord shifting by extensive posterior decompression clinically significant for multisegmental cervical spondylotic myelopathy? Spine (Phila Pa 1976), 2005, 30(21): 2414-2419.
14. Sakaura H, Hosono N, Mukai Y, et al. Long-term outcome of laminoplasty for cervical myelopathy due to disc herniation: a comparative study of laminoplasty and anterior spinal fusion. Spine (Phila Pa 1976), 2005, 30(7): 756-759.
15. Hosono N, Sakaura H, Mukai Y, et al. The source of axial pain after cervical laminoplasty-C7 is more crucial than deep extensor muscles. Spine (Phila Pa 1976), 2007, 32(26): 2985-2988.
16. Roy-Camile R, Saillant G, Mazel C. Internal fixation of the unstable cervical spine by a posterior osteosynthesis with plate and screw//Cervical Spine Research Society. The Cervical Spine. 2nd ed. Philadelphia Pa: JB Lippincott, 1989: 390-403.
17. Coe JD, Warden KE, Sutterlin CE, et al. Biomechanical evaluation of cervical spinal stabilization methods in a human cadaveric model. Spine (Phila Pa 1976), 1989, 14(10): 1122-1131.
18. Nassr A, Eck JC, Ponnappan RK, et al. The incidence of C5 Palsy after multilevel cervical decompression procedures: A review of 750 consecutive cases. Spine (Phila Pa 1976), 2012, 37(3): 174-178.
19. Imagama S, Matsuyama Y, Yukawa Y, et al. C5 palsy after cervical laminoplasty: a multicentre study. J Bone Joint Surg (Br), 2010, 92(3): 393-400.
20. Kaiser MG , Mummaneni PV, Matz PG, et al. Radiographic assessment of cervical subaxial fusion. J Neurosurg Spine, 2009, 11(2): 221-227.
21. 阮狄克. 颈椎融合加速相邻节段退变: 真实还是虚构？中国脊柱脊髓杂志, 2011, 21(1): 6-7.
22. 王义生. 脊柱融合术与非融合术不是相互替代而是互补？中国脊柱脊髓杂志, 2011, 21(1): 7-8.
23. Wang MY, Green BA, Vitarbo E, et al. Adjacent segment disease: an uncommon complication after cervical expansile laminoplasty: case report. Neurosurgery, 2003, 53(3): 770-773.
24. Huang RC, Girardi FP, Poynton AR, et al. Treatment of multilevel cervical spondylotic myeloradiculopathy with posterior decompression and fusion with lateral mass plate fixation and local bone graft. J Spinal Disord Tech, 2003, 16(2): 123-129.
25. Takeuchi K, Yokoyama T, Aburakawa S, et al. Axial symptoms after cervical laminoplasty with C3 laminectomy compared with conventional C3-C7 laminoplasty: a modified laminoplasty preserving the semispinalis cervicis inserted into axis. Spine (Phila Pa 1976), 2005, 30(22): 2544-2549.
26. Takeuchi K, Yokoyama T, Ono A, et al. Cervical range of motion and alignment after laminoplasty preserving or reattaching the semispinalis cervicis inserted into axis. J Spinal Disord Tech, 2007, 20(8): 571-576.

Chinese Journal of Reparative and Reconstructive Surgery

COMPARISON OF EFFECTIVENESS BETWEEN LAMINOPLASTY AND LAMINECTOMY DECOMPRESSION AND FUSION WITH INTERNAL FIXATION FOR CERVICAL SPONDYLOTIC MYELOPATHY

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