Skip to main content
SpringerLink
Log in

Laminoplasty versus Laminectomy and Fusion for Multilevel Cervical Spondylotic Myelopathy

  • Symposium: Current Concepts in Cervical Spine Surgery
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Cervical spondylotic myelopathy is increasingly prevalent in the elderly and is the leading cause of spinal cord dysfunction in this population. Laminectomy with fusion and laminoplasty halt progression of myelopathy in these patients; however, both procedures have well-documented complications and associated morbidity and it is unclear which might be most advantageous.

Questions/purposes

We therefore compared the pain, function and alignment of patients who underwent laminectomy with fusion to those with laminoplasty for the treatment of multilevel cervical spondylotic myelopathy.

Methods

We performed a retrospective matched cohort analysis on all 121 patients from 2002 to 2007 who underwent laminectomy with fusion (82) or laminoplasty (39) for multilevel cervical spondylotic myelopathy. We determined change in preoperative and postoperative sagittal alignment using Cobb measurement, development of junctional stenosis, and subjective improvements in pain and gait. Complications were recorded for both cohorts.

Results

The majority of patients in both cohorts reported improvements in pain and gait postoperatively. There were seven complications in the laminectomy and fusion cohort (9%) with two patients requiring formal revision surgery (2%). There were five complications in the laminoplasty cohort (13%) with two formal revision procedures (5%).

Conclusions

Patients in both the laminectomy with fusion and laminoplasty cohorts reported similar functional improvements after treatment for cervical spondylotic myelopathy. Prospective randomized control trials are needed to determine whether one procedure is truly superior.

Level of Evidence

Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1A–C
Fig. 2A–B
Fig. 3A–C

Similar content being viewed by others

References

  1. Baba H, Uchida K, Maezawa Y, Furusawa N, Azuchi M, Imura S. Lordotic alignment and posterior migration of the spinal cord following en bloc open-door laminoplasty for cervical myelopathy: a magnetic resonance imaging study. J Neurol. 1996;243:626–632.

    Article  CAS  PubMed  Google Scholar 

  2. Bucciero A, Vizioli L, Carangelo B, Tedeschi G. MR signal enhancement in cervical spondylotic myelopathy: correlation with surgical results in 35 cases. J Neurosurg Sci. 1993;37:217–222.

    CAS  PubMed  Google Scholar 

  3. Butler JC, Whitecloud TS. Postlaminectomy kyphosis: causes and surgical management. Orthop Clin North Am. 1992;23:505–511.

    CAS  PubMed  Google Scholar 

  4. Cherubino P, Benazzo F, Borromeo U, Perle S. Degenerative arthritis of the adjacent spinal joints following anterior cervical spinal fusion: clinicoradiologic and statistical correlations. Ital J Orthop Traumatol. 1990;16:533–543.

    CAS  PubMed  Google Scholar 

  5. Clarke E, Robinson PK. Cervical myelopathy: a complication of cervical spondylosis. Brain. 1956;79:483–510.

    Article  CAS  PubMed  Google Scholar 

  6. Dai L, Ni B, Yuan W, Jia L. Radiculopathy after laminectomy for cervical compression myelopathy. J Bone Joint Surg Br.1998;80:846–849.

    Article  CAS  PubMed  Google Scholar 

  7. Edwards CC, Heller JG, Silcox DH. T-Saw laminoplasty for the management of cervical spondylotic myelopathy: clinical and radiographic outcome. Spine (Phila Pa 1976). 2000;25:1788–1794.

    Google Scholar 

  8. Fujiwara K, Yonenobu K, Ebara S, Yamashita K, Ono K. The prognosis of surgery for cervical compression myelopathy: an analysis of the factors involved. J Bone Joint Surg Br. 1989;71:393–398.

    CAS  PubMed  Google Scholar 

  9. Gok B, McLoughlin GS, Sciubba DM, McGirt MJ, Chaichana KL, Wolinsky JP, Bydon A, Gokaslan ZL, Witham TF. Surgical management of cervical spondylotic myelopathy with laminectomy and instrumented fusion. Neurol Res. 2009;31:1097–1101.

    Article  PubMed  Google Scholar 

  10. Gonzalez-Feria L, Peraita-Peraita P. Cervical spondylotic myelopathy: a cooperative study. Clin Neurol Neurosurg. 1975;78:19–33.

    Article  CAS  PubMed  Google Scholar 

  11. Guigui P, Benoist M, Deburge A. Spinal deformity and instability after multilevel cervical laminectomy for spondylotic myelopathy. Spine(Phila Pa 1976) 1998;23:440–447.

    CAS  Google Scholar 

  12. Heller JG, Edwards CC, Murakami H, Rodts GE. Laminoplasty versus laminectomy and fusion for multilevel cervical myelopathy: an independent matched cohort analysis. Spine (Phila Pa 1976). 2001;26:1330–1336.

    CAS  Google Scholar 

  13. Hosono N, Yonenobu K, Ono K. Neck and shoulder pain after laminoplasty: a noticeable complication. Spine (Phila Pa 1976). 1996;21:1969–1973.

    CAS  Google Scholar 

  14. 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;52:1081–1087; discussion 1087–1088.

    Google Scholar 

  15. Huang RC, Girardi FP, Poynton AR, Cammisa FP Jr. 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;16:123–129.

    Article  PubMed  Google Scholar 

  16. Kato Y, Iwasaki M, Fuji T, Yonenobu K, Ochi T. Long-term follow-up results of laminectomy for cervical myelopathy caused by ossification of the posterior longitudinal ligament. J Neurosurg. 1998;89:217–223.

    Article  CAS  PubMed  Google Scholar 

  17. Kawakami M, Tamaki T, Iwasaki H, Yoshida M, Ando M, Yamada H. A comparative study of surgical approaches for cervical compressive myelopathy. Clin Orthop Relat Res. 2000:381;129–136.

    Article  PubMed  Google Scholar 

  18. Kumar VG, Rea GL, Mervis LJ, McGregor JM. Cervical spondylotic myelopathy: functional and radiographic long-term outcome after laminectomy and posterior fusion. Neurosurgery. 1999;44:771–777; discussion 777–778.

    Google Scholar 

  19. Lee JY, Hanks SE, Oxner W, Tannoury C, Donaldson WF, Kang JD. Use of small suture anchors in cervical laminoplasty to maintain canal expansion: a technical note. J Spinal Disord Tech. 2007;20:33–35.

    Article  PubMed  Google Scholar 

  20. Lonstein JE. Post-laminectomy kyphosis. Clin Orthop Relat Res. 1977;128:93–100.

    PubMed  Google Scholar 

  21. Maurer PK, Ellenbogen RG, Ecklund J, Simonds GR, Van Dam B, Ondra SL. Cervical spondylotic myelopathy: treatment with posterior decompression and Luque rectangle bone fusion. Neurosurgery. 1991;28:680–683; discussion 683–684.

    Google Scholar 

  22. Rao RD, Gourab K, David KS. Operative treatment of cervical spondylotic myelopathy. J Bone Joint Surg Am. 2006;88:1619–1640.

    Article  PubMed  Google Scholar 

  23. Ratliff JK, Cooper PR. Cervical laminoplasty: a critical review. J Neurosurg 2003;98:230–238.

    PubMed  Google Scholar 

  24. Satomi K, Nishu Y, Kohno T, Hirabavashi K. Long-term follow-up studies of open-door expansive laminoplasty for cervical stenotic myelopathy. Spine (Phila Pa 1976). 1994;19:507–510.

    CAS  Google Scholar 

  25. Sodeyama T, Goto S, Mochizuki M, Takahashi J, Moriya H. Effect of decompression enlargement laminoplasty for posterior shifting of the spinal cord. Spine (Phila Pa 1976). 1999;24:1527–1531; discussion 1531-1532.

    Google Scholar 

  26. Suri A, Chabbra RP, Mehta VS, Gaikwad S, Pandey RM. Effect of intramedullary signal changes on the surgical outcome of patients with cervical spondylotic myelopathy. Spine J. 2003;3:33–45.

    Article  PubMed  Google Scholar 

  27. Tomita K, Kawahara N, Toribatake Y, Heller JG. Expansive midline T-saw laminoplasty (modified spinous process-splitting) for the management of cervical myelopathy. Spine (Phila Pa 1976). 1998;23:32–37.

    CAS  Google Scholar 

  28. Wang MY, Shah S, Green BA. Clinical outcomes following cervical laminoplasty for 204 patients with cervical spondylotic myelopathy. Surg Neurol. 2004;62:487–492; discussion 492–493.

    Google Scholar 

  29. Yonenobu K, Fuji T, Ono K, Okada K, Yamamoto T, Harada N. Choice of surgical treatment for multisegmental cervical spondylotic myelopathy. Spine (Phila Pa 1976). 1985;10:710–716.

    CAS  Google Scholar 

  30. Yonenobu K, Hosono N, Iwasaki M, Asano M, Ono K. Laminoplasty versus subtotal corpectomy: a comparative study of results in multisegmental cervical spondylotic myelopathy. Spine (Phila Pa 1976). 1992;17:1281–1284.

    CAS  Google Scholar 

Download references

Acknowledgments

We thank Cara Davies and Robert Hartman for their vital contributions with data collection and statistical analysis, which aided in the completion of this manuscript.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Barrett I. Woods MD, Justin Hohl MD, Joon Lee MD, William Donaldson III MD & James Kang MD

  2. The Ferguson Lab for Orthopaedic and Spine Research, 200 Lothrop Street, EBST 1641, Pittsburgh, PA, 15213, USA

    James Kang MD

Authors
  1. Barrett I. Woods MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Justin Hohl MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Joon Lee MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. William Donaldson III MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. James Kang MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to James Kang MD.

Additional information

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution approved or waived approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

This work was performed at The Ferguson Lab for Orthopaedic and Spine Research, University of Pittsburgh Medical Center.

About this article

Cite this article

Woods, B.I., Hohl, J., Lee, J. et al. Laminoplasty versus Laminectomy and Fusion for Multilevel Cervical Spondylotic Myelopathy. Clin Orthop Relat Res 469, 688–695 (2011). https://doi.org/10.1007/s11999-010-1653-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-010-1653-5

Keywords

Search

Navigation