Laminoplasty-an underutilized procedure for cervical spondylotic myelopathy

Spine J. 2021 Apr;21(4):571-577. doi: 10.1016/j.spinee.2020.10.021. Epub 2020 Nov 2.

Abstract

Background content: Cervical laminoplasty (LP) and laminectomy and fusion (LF) are commonly used surgical techniques for cervical spondylotic myelopathy (CSM). Several recent studies have demonstrated superior perioperative metrics and decreased overall costs with LP, yet LF is performed far more often in the United States.

Purpose: To determine the percentage of patients with CSM who are radiographically candidates for LP.

Study design: Retrospective comparative cohort study.

Patient sample: Patients >18 years old who underwent LF or LP for CSM at 2 large academic institutions from 2017 to 2019.

Outcome measures: Candidacy for LP based on radiographic criteria.

Methods: Radiographs were assessed by 2 spine surgeons not involved in the care of the patients to determine the C2-C7 Cobb angle and the presence and extent of cervical instability. Patients with kyphosis >13°, > 3.5 mm of listhesis on static imaging, or > 2.5 mm of motion on flexion-extension or standing-supine films were not considered candidates for LP. Intraclass coefficient (ICC) was calculated to assess the interobserver reliability of angular measurements and the presence of instability. The percentage of patients for whom LP was contraindicated was calculated.

Results: One hundred eight patients underwent LF while 142 underwent LP. Of the 108 patients who underwent LF, 79.6% were radiographically deemed candidates for LP, as were all 142 patients who underwent LP. The ICC for C2-C7 alignment was 0.90; there was 97% agreement with respect to the presence of instability.

Conclusions: In 250 patients with CSM, 228 (91.2%) were radiographically candidates for LP. These data suggest that LP may be an underutilized procedure for the treatment for CSM.

Keywords: Cervical laminoplasty; Cervical spondylotic myelopathy; Cervical stenosis; Laminoplasty; Myelopathy; Posterior cervical laminectomy and fusion.

MeSH terms

  • Adolescent
  • Cervical Vertebrae / diagnostic imaging
  • Cervical Vertebrae / surgery
  • Cohort Studies
  • Humans
  • Laminectomy
  • Laminoplasty*
  • Reproducibility of Results
  • Retrospective Studies
  • Spinal Cord Diseases* / diagnostic imaging
  • Spinal Cord Diseases* / surgery
  • Spinal Fusion*
  • Spondylosis* / diagnostic imaging
  • Spondylosis* / surgery
  • Treatment Outcome