Laminoplasty versus laminectomy and fusion for multilevel cervical myelopathy - An independent matched cohort analysis

Study Design. A matched cohort clinical and radiographic retrospective anal ysis of laminoplasty and laminectomy with fusion for the treatment of multi level cervical myelopathy. Objectives. To compare the clinical and radiographic outcomes of two proced ures increasingly used to treat multilevel cervical myelopathy. Summary of Background Data. Traditional methods of treating multilevel cerv ical myelopathy (laminectomy and corpectomy) are reported to have a notable frequency of complications. Laminoplasty and laminectomy with fusion have been advocated as superior procedures. A comparative study of these two tec hniques has not been reported. Methods. Medical records of all patients treated for multilevel cervical my elopathy with either laminoplasty or laminectomy with fusion between 1994 a nd 1999 at our institution were reviewed. Thirteen patients that underwent laminectomy with fusion were matched with 13 patients that underwent lamino plasty. All patients and radiographs were independently evaluated at latest follow-up by a single physician. Results. Cohorts were well matched based on patient age, duration of sympto ms, and severity of myelopathy (Nurick grade) before surgery. Mean independ ent follow-up was similar (25.5 and 26.2 months). Both objective improvemen t in patient function (Nurick score) and the number of patients reporting s ubjective improvement in strength, dexterity, sensation, pain, and gait ten ded to be greater in the laminoplasty cohort. Whereas no complications occu rred in the laminoplasty cohort, there were 14 complications in 9 patients that underwent laminectomy with fusion patients. Complications included pro gression of myelopathy, nonunion, instrumentation failure, development of a significant kyphotic alignment, persistent bone graft harvest site pain, s ubjacent degeneration requiring reoperation, and deep infection. Conclusions. The marked difference in complications and functional improvem ent between these matched cohorts suggests that laminoplasty may be prefera ble to laminectomy with fusion as a posterior procedure for multilevel cerv ical myelopathy.