Title : A comprehensive evaluation of posterior surgical approaches in the management of cervical spondylotic myelopathy: Laminoplasty versus laminectomy with fusion
Abstract:
Background: Widespread uncertainty persists in the surgical community on the optimal treatment for cervical spondylotic myelopathy (CSM), specifically on whether laminoplasty or laminectomy with fusion is superior. This study seeks to compare clinical outcomes, radiographic outcomes, perioperative data, and the complications of both procedures to ascertain a superior technique.
Study Design: Systematic Review
Methods: An in-depth review of the literature was conducted between October and December 2023 on PubMed, Embase, and Medline to locate literature comparing laminoplasty to laminectomy with fusion for cervical spondylotic myelopathy. Data presenting from the studies was collected and interpreted to produce a systematic review of the surgical outcomes. Exclusion criteria of age<18, history of traumatic spinal injury, prior surgery for CSM, and supplementary anterior surgery was used.
Results: A total of 18 studies were located, representing 1448 and 3941 patients undergoing laminoplasty and laminectomy with fusion respectively. There were no significant differences in MJOA, Nurrick, NDI, and SF-36 outcome measures. Patients undergoing laminoplasty experienced significantly reduced blood loss, operative times, and hospital length of stays. For laminectomy with fusion, patients saw better VAS outcomes whilst experiencing a greater incidence of C5 palsy, surgical site infections, reoperation rates, and overall complications. The cervical range of motion was preserved to a greater extent following laminoplasty, while laminectomy with fusion saw reduced loss of lordosis and C2-C7 Sagittal Vertical Axis.
Conclusions: Based off these results, neither laminoplasty of laminectomy with fusion Conclusions: Based off these results, neither laminoplasty of laminectomy with fusion can can be claimed as superior. Surgeons must
be claimed as superior. Surgeons must instead be proficient in both approaches and take
patient factors into consideration before proceeding with either surgical approach to obtain the best outcomes for patients. Evidence-based guidelines would be fundamental in this goal.
