An Observational Study Comparing Laminoplasty versus Lateral Mass Screw Fixation in Multilevel Cervical Compressive Myelopathy

Abstract Background: The management of multilevel degenerative cervical myelopathy (DCM) is still controversial. Patients with DCM can be treated nonsurgically or surgically, depending on symptom progression, severity, and radiological characteristics. Surgical treatment can be performed using either an anterior or posterior approach or both in some circumstances, each with a unique set of indications and limitations. Objective: The objective of the study was to compare the outcomes of laminoplasty (LP) and laminectomy with lateral mass fixation (LMS) in multilevel DCM. Material and Methods: Patients with cervical compressive myelopathy operated by posterior approach between January 2021 and December 2023 were included. Outcomes were assessed with a modified Japanese Orthopaedic Association score (mJOA), Nurick grade, neck disability index (NDI), and Ishihara score (cervical curvature index [CCI]). Results: Forty patients were included of which 16 patients underwent LP and 24 patients underwent LMS. Significant improvement was noted postoperatively in both the groups in mJOA score, Nurick grade, and NDI. No gross improvement was seen in CCI. Operative time and implant cost per level were significantly less in LP. Recovery rates were comparable in all the measured parameters, namely mJOA score, Nurick grade, NDI, and Ishihara index in both groups. Conclusions: LP and lateral mass fixation lead to significant clinical improvement with no significant worsening in cervical lordosis. LP had less operative time with a better range of cervical motion and a cost-effective procedure in patients without cervical deformity while LMS was found to be more appropriate for kyphotic/deformed cervical spine.