Functional Outcome of Multilevel Cervical Laminectomy and Instrumentation with Lateral Mass Screw for Multilevel Cervical Myelopathy

Background: Posterior cervical laminectomy and instrumentation is procedure to treat multilevel cervical myelopathy. In this study we evaluate the outcome of multilevel cervical laminectomy and stabilization with lateral mass screw fixation in patients with multilevel cervical spine myelopathy and its outcome in terms of spinal cord decompression, neurological function, and spinal alignment. Materials and Method: This was a prospective and retrospective single-center study of patients who underwent Posterior Cervical Laminectomy and Fixation for Cervical Myelopathy. The study was performed at the Civil Hospital Ahmedabad’s Orthopaedic department in Ahmedabad from 2022 to 2024. During this period, 50 patients (total group) were eligible for inclusion, and we obtained complete preoperative and follow-up data at 3, 6, 9 and 12 months for 50 patients. Result: In our study, it consisted of 50 patients with 12 months of follow-up. Majority of the patients in the study were total 40 male and 10 female. Most common level operated was C4-C6. The average age of patients was 56 years. Younger age and lesser duration of symptoms is associated with better outcome. Both Nurick grading and mJOA grading should be used to evaluate cervical spine patients as both provide an insight into the grade of disease and the improvement on successful decompression. Nurick grade preoperatively, postoperatively and 3,6, 12 months follow up were 2.9, 2.3 and 1.5, 1, 0.4 respectively, which is clinically significant (p=0.0001 and p<0.05), and depicts a good clinical outcome related to solid fusion and decompression. Mean mJOA preoperatively, postoperatively and 3,6, 12 months follow up were 1.8, 1.2 and 0.9, 0.3, 0.04 respectively. mJOA score improved significantly at follow up (p=0.0001 and p<0.05). In this study, the mean NDI preoperative, postoperative and 3,6, 12 months follow up were 56.6%, 42.8% and 30.2%, 19.8%, 13.1% respectively. NDI has decreased significantly at follow up (p=0.0001 and p<0.05), which is consistent with the fact that fusion leads to decreased motion at affected segment and thus decreased neck pain and discomfort. Pain in the neck was also assessed by VAS scores which preoperatively, postoperatively and 3,6, 12 months follow up were 6.2, 4.8 and 3.2, 1.8, 1.2 respectively. Pain VAS has decreased significantly (p= 0.0001 and p<0.05) in this study and consistent with the findings of neck disability index pointing towards a good clinical outcome in patients of acdf. Fusion was found to be an extremely important parameter for determining outcome. NDI scores were found to be significantly higher among patients in whom fusion was not achieved or has yet to be achieved. Neck VAS scores were also found to be significantly less among the patients who achieved fusion. Almost all patients have maintained their lordotic curve in cervical spine post operatively. Conclusion: The multilevel cervical laminectomy and instrumentation with lateral mass screw for multilevel cervical myelopathy is a safe technique that provides decompression of the spinal cord, prevents the development of kyphotic spinal deformity and significant improvement in NURICK & MJOA score with decrease in neck pain and discomfort which is assessed via VAS score.