Cervical laminectomy for the treatment of cervical degenerative myelopathy

Timothy C. Ryken Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa;

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Robert F. Heary Department of Neurosurgery, University of Medicine and Dentistry of New Jersey—New Jersey Medical School, Newark, New Jersey;

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Paul G. Matz Division of Neurological Surgery, University of Alabama, Birmingham, Alabama;

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Paul A. Anderson Departments of Orthopaedic Surgery and

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Michael W. Groff Department of Neurosurgery, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts;

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Langston T. Holly Division of Neurosurgery, David Geffen School of Medicine, University of California at Los Angeles, California;

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Michael G. Kaiser Department of Neurological Surgery, Neurological Institute, Columbia University, New York, New York;

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Praveen V. Mummaneni Department of Neurosurgery, University of California at San Francisco, California;

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Tanvir F. Choudhri Department of Neurosurgery, Mount Sinai School of Medicine, New York, New York; and

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Edward J. Vresilovic Department of Orthopaedic Surgery, Milton S. Hershey Medical Center, Pennsylvania State College of Medicine, Hershey, Pennsylvania

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Daniel K. Resnick Neurological Surgery, University of Wisconsin, Madison, Wisconsin;

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Object

The objective of this systematic review was to use evidence-based medicine to examine the efficacy of cervical laminectomy for the treatment of cervical spondylotic myelopathy (CSM).

Methods

The National Library of Medicine and Cochrane Database were queried using MeSH headings and keywords relevant to cervical laminectomy and CSM. Abstracts were reviewed after which studies meeting inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I–III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons.

Results

Laminectomy has improved functional outcome for symptomatic cervical myelopathy (Class III). The limitations of the technique are an increased risk of postoperative kyphosis compared to anterior techniques or laminoplasty or laminectomy with fusion (Class III). However, the development of kyphosis may not necessarily to diminish the clinical outcome (Class III).

Conclusions

Laminectomy is an acceptable therapy for near-term functional improvement of CSM (Class III). It is associated with development of kyphosis, however.

Abbreviations used in this paper:

ACD = anterior cervical discectomy; CSM = cervical spondylotic myelopathy; ROM = range of motion.
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