Subtotal corpectomy versus laminoplasty for multilevel cervical spondylotic myelopathy - A long-term follow-up study over 10 years

Design. A retrospective study was conducted. Objective. To compare the long-term outcomes of subtotal corpectomy and lam inoplasty for multilevel cervical spondylotic myelopathy. Summary of Background Data. No study has compared the long-term outcomes be tween subtotal corpectomy and laminoplasty for multilevel cervical spondylo tic myelopathy, Methods. In this study, 23 patients treated with subtotal corpectomy and 24 patients treated with laminoplasty were followed up for 10 to 14 years aft er surgery. Neurologic recovery, late deterioration, axial pain, radiograph ic results (degenerative changes at adjacent levels, alignment and range of motion of the cervical spine), and surgical complications were compared be tween the two groups. Results. No significant difference in neurologic recovery was found between the two groups 1 and 5 years after surgery, or at the latest follow-up ass essment. Neurologic status deteriorated in one patient of the subtotal corp ectomy group because of adjacent degeneration, and in one patient of the la minoplasty group because of hyperextension injury. Axial pain was observed in 15% of the corpectomy group and in 40% of the laminoplasty group (P < 0. 05), In the corpectomy group, listhesis exceeding 2 mm developed at 38% of the upper adjacent levels, and osteophyte formation at 54% of the lower adj acent levels. In the laminoplasty group, kyphotic deformity developed in on e patient (6%) after surgery. In the corpectomy group, the mean vertebral r ange of motion had decreased from 39.4 degrees to 19.2 degrees (49%) by the final follow-up assessment, in the laminoplasty group, the mean vertebral range of motion had decreased from 40.2 degrees to 11.6 degrees (29%) by th e final follow-up assessment. Neurologic complications related to the surge ry occurred in two patients tone myelopathy from bone graft dislodgement an d one C5 root palsy from bone graft fracture) of the corpectomy group and f our patients (C5 root palsy) of the laminoplasty group. All of these patien ts recovered over time. The corpectomy group needed longer operative time ( P < 0.001) and fended to have more blood loss (P = 0.24). Six patients in t he corpectomy group needed posterior interspinous wiring because of pseudar throsis. Conclusions, Subtotal corpectomy and laminoplasty showed an identical effec t from a surgical treatment for multilevel cervical spondylotic myelopathy. These neurologic recoveries usually last more than 10 years. In the subtot al corpectomy group; the disadvantages were longer surgical time, more bloo d loss, and pseudarthrosis: in the laminoplasty group; axial; pain occurren ce frequently, and the range of motion was reduced severely.