Laminoplasty (LP) Versus Laminectomy and Fusion (LF) For Multilevel Cervical Myelopathy: A Single-Center Study

Abstract Background: Cervical laminoplasty (LP) and cervical laminectomy plus fusion are standard procedures that treat compressive cervical myelopathy (CCM) by expanding the space available for the spinal cord. Although there are strong proponents of each procedure, the effectiveness, safety, and differential effectiveness of LP versus laminectomy and fusion (LF) remain unclear. Materials and Methods: A total of 60 patients with CCM who had undergone a standard LP (30 patients) or cervical LF (30 patients) between January 2017 and January 2022, with 1-year follow-up, were reviewed. Cohorts were matched with respect to age, sex, duration of symptoms, and cervical lordosis (C2–C7). The clinical outcome was analyzed by visual analog scale (VAS) for neck pain, modified Japanese Orthopedic Association (mJOA) score, and Nurick grading at diagnosis, immediate post-operative, 3 months, and at 1 year post-operatively and was compared. Duration of surgery and blood loss were also compared along with post-operative complications. Pre- and 1-year post-operative magnetic resonance imaging (MRI), along with cervical lordosis in standing X-ray, was compared. Spinal cord drift was assessed in 12 months post-operative MRI. Results: Both groups similarly improved in the mJOA score and Nurick grade, but the neck pain VAS score significantly improved in the LF group post-operatively ( P = 0.03). Duration of surgery and blood loss were found to be more in patients who underwent LF ( P = 0.137 for duration of surgery and 0.001 for blood loss). Seven patients in the LF group and six patients in the LP group showed grade 1 improvement in Chen grading MRI at 1-year follow-up. Eleven patients who underwent LF and eight patients who underwent LP encountered complications after surgery ( P = 0.21). Complications included infection, C5 palsy, neurologic deterioration, and urinary incontinence. Spinal cord drift was found to be more (mean cord drift in LF 2.66 ± 0.77 and in LP 2.16 ± 0.8) and statistically significant ( P = 0.049) in the LF group when compared to the LP group. Conclusion: Both groups led to clinical improvement (improvement in Nurick grade, mJOA scores, and VAS pain scores) and loss of lordosis at 1-year follow-up, but at the end of 1 year, the difference in cervical lordosis was significantly less in the LF group. There is no evidence to support LP over LF or vice-versa in the treatment of multilevel CCM.