Treatment of cervical stenotic myelopathy: a cost and outcome comparison of laminoplasty versus laminectomy and lateral mass fusion

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Object

Cervical stenotic myelopathy due to spondylosis or ossification of the posterior longitudinal ligament is often treated with laminoplasty or cervical laminectomy (with fusion). The goal of this study was to compare outcomes, radiographic results, complications, and implant costs associated with these 2 treatments.

Methods

The authors analyzed the records of 56 patients (age range 42–81 years) who were surgically treated for cervical stenosis. Of this group, 30 underwent laminoplasty and 26 underwent laminectomy with fusion. Patients who had cervical kyphosis or spondylolisthesis were excluded. An average of 4 levels were instrumented in the laminoplasty group and 5 levels in the fusion group (p < 0.01). Forty-two percent of the fusions crossed the cervicothoracic junction, but no laminoplasty instrumentation crossed the cervicothoracic junction, and it only reached C-7 in one-third of the cases. Preoperative and postoperative Nurick grades and modified Japanese Orthopaedic Association (mJOA) scores were obtained. Outcomes were also assessed with neck pain visual analog scale (VAS) scores and the Odom outcome criteria. Postoperative length of stay, complications, and implant costs were calculated.

Results

The mean duration of follow-up, average patient age, and length of hospital stay were similar for both groups. The mean Nurick scores were also similar in the 2 groups and improved an average of 1.4 points in both (p < 0.01 for preoperative-postoperative comparison in each group). The mean mJOA scores improved 2.7 points in laminoplasty patients and 2.8 points in fusion patients (p < 0.01 for each group). The mean VAS scores for neck pain did not change significantly in the laminoplasty cohort (3.2 ± 2.8 [SD] preoperatively vs 3.4 ± 2.6 postoperatively, p = 0.50). In the fusion cohort, the mean VAS scores improved from 5.8 ± 3.2 to 3.0 ± 2.3 (p < 0.01). Excellent or good Odom outcomes were observed in 76.7% of the patients in the laminoplasty cohort and 80.8% of those in the fusion cohort (p = 0.71). In the fusion group, complications were twice as common and implant costs were nearly 3 times as high as in the laminoplasty group. When cases involving fusions crossing the cervicothoracic junction were excluded, analysis showed similar complication rates in the 2 groups.

Conclusions

Patients treated with laminoplasty and patients treated with laminectomy and fusion had similar improvements in Nurick scores, mJOA scores, and Odom outcomes. Patients who underwent fusion typically had higher preoperative neck pain scores, but their neck pain improved significantly after surgery. There was no significant change in the neck pain scores of patients treated with laminoplasty. Our series suggests cervical fusion significantly reduces neck pain in patients with stenotic myelopathy, but that the cost of the implant and rate of reoperation are greater than in laminoplasty.

Abbreviations used in this paper: mJOA = modified Japanese Orthopaedic Association; VAS = visual analog scale.

Article Information

Address correspondence to: Praveen V. Mummaneni, M.D., UCSF Spine Center, University of California, San Francisco, 400 Parnassus Avenue, 3rd Floor, San Francisco, California 94143. email: vmum@aol.com.

Please include this information when citing this paper: published online February 25, 2011; DOI: 10.3171/2011.1.SPINE10206.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Sagittal T2-weighted MR image revealing circumferential cervical stenosis from C-3 to C-6 with maintained cervical lordosis.

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    Artist's illustration of the drilling of a complete unilateral trough during the laminoplasty procedure. Initially, the trough is drilled perpendicular to the lateral mass. Subsequently, a more medial trajectory is taken with the drill to enter the lateral spinal canal.

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    Artist's illustration of unilateral full-thickness laminoplasty trough with a contralateral partial-thickness trough.

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    Intraoperative photograph of an open-door laminoplasty.

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    Axial CT scan of an open-door laminoplasty. Note the expanded canal size and the “open door” hinged on the partially drilled trough.

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    Lateral radiograph obtained after C3–6 laminectomies with lateral mass fixation.

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    Left: Flexion radiograph after laminoplasty revealing asymptomatic screw backout from the lamina of C-5. Right: Extension radiograph revealing asymptomatic partial backout of a C-5 laminoplasty screw.

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