Laminectomy and fusion for the treatment of cervical degenerative myelopathy

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  • 1 Departments of Orthopaedic Surgery and
  • | 11 Neurological Surgery, University of Wisconsin, Madison, Wisconsin;
  • | 2 Division of Neurological Surgery, University of Alabama, Birmingham, Alabama;
  • | 3 Department of Neurosurgery, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts;
  • | 4 Department of Neurosurgery, University of Medicine and Dentistry of New Jersey—New Jersey Medical School, Newark, New Jersey;
  • | 5 Division of Neurosurgery, David Geffen School of Medicine, University of California at Los Angeles, California;
  • | 6 Department of Neurological Surgery, Neurological Institute, Columbia University, New York, New York;
  • | 7 Department of Neurosurgery, University of California at San Francisco, California;
  • | 8 Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa;
  • | 9 Department of Neurosurgery, Mount Sinai School of Medicine, New York, New York; and
  • | 10 Department of Orthopaedic Surgery, Milton S. Hershey Medical Center, Pennsylvania State College of Medicine, Hershey, Pennsylvania
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Object

The objective of this systematic review was to use evidence-based medicine to examine the efficacy of cervical laminectomy and fusion 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, fusion, and CSM. Abstracts were reviewed, after which studies that met the inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Class I–III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations which 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

Cervical laminectomy with fusion (arthrodesis) improves functional outcome in patients with CSM and ossification of the posterior longitudinal ligament (OPLL). Functional improvement is similar to laminectomy or laminoplasty for patients with CSM and OPLL. In contrast to laminectomy, cervical laminectomy with fusion it is not associated with late deformity (Class III).

Conclusions

Laminectomy with fusion (arthrodesis) is an effective strategy to improve functional outcome in CSM and OPLL.

Abbreviations used in this paper:

CSM = cervical spondylotic myelopathy; JOA = Japanese Orthopaedic Association; OPLL = ossification of the posterior longitudinal ligament.

Spine - 1 year subscription bundle (Individuals Only)

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JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

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  • 1

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