Surgical outcomes following laminectomy with fusion versus laminectomy alone in patients with degenerative cervical myelopathy

Mark R.N. Kotter, Lindsay Tetreault, Jetan H. Badhiwala, Jefferson R. Wilson, Paul M. Arnold, Ronald Bartels, Giuseppe Barbagallo, Branko Kopiar, Michael G. Fehlings

Research output: Contribution to journalArticlepeer-review

Abstract

Study Design. Post-hoc analysis of a prospective observational cohort study. Objective. To compare clinical outcomes following laminectomy and fusion versus laminectomy alone in an international series of individuals suffering from degenerative cervical myelopathy (DCM). Summary of Background Data. Significant controversy exists regarding the role of instrumented fusion in the context of posterior surgical decompression for DCM. A previous study comparing laminectomy and fusion with laminoplasty showed no differences in outcomes between groups after adjusting for preoperative characteristics. Methods. Based on the operation they received, 208 of the 757 patients prospectively enrolled in the AO Spine North America or International studies at 26 global sites were included in the present study. Twenty-two patients were treated with laminectomy alone and 186 received a laminectomy with fusion. Patients were evaluated using the modified Japanese Orthopedic Association scale (mJOA), Nurick score, Neck Disability Index, and SF36 quality of life measure. Baseline and surgical characteristics were compared using a t test for continuous variables and a chi-square test for categorical variables. A mixed model analytic approach was used to evaluate differences in outcomes at 24 months between patients undergoing laminectomy and fusion versus laminectomy alone. Results. Surgical cohorts were comparable in terms of preoperative patient characteristics. Patients undergoing laminectomy with instrumented fusion had a significantly longer operative duration (P < 0.0001, 231.44 vs. 107.10 min) but a comparable length of hospital stay. In terms of outcomes, patients treated with laminectomy with fusion exhibited clinically meaningful improvements (in functional impairmentDmJOA ¼ 2.48, DNurick ¼ 1.19), whereas those who underwent a laminectomy without fusion did not (DmJOA ¼ 0.78; DNurick ¼ 0.29). There were significant differences between surgical cohorts in the change in mJOA and Nurick scores from preoperative to 24-months postoperative (mJOA: -1.70, P ¼ 0.0266; Nurick: -0.90, P ¼ 0.0241). The rate of perioperative complications was comparable (P ¼ 0.879). Conclusion. Our findings suggest that cervical laminectomy with instrumented fusion is more effective than laminectomy alone at improving functional impairment in patients with DCM. These results warrant confirmation in larger prospective comparative studies.

Original languageEnglish (US)
Pages (from-to)1696-1703
Number of pages8
JournalSpine
Volume45
Issue number24
DOIs
StatePublished - Dec 15 2020
Externally publishedYes

Keywords

  • Cervical spinal stenosis
  • Degenerative cervical myelopathy
  • Laminectomy
  • Laminectomy and instrumented fusion
  • Length of hospital stay
  • Minimum clinically important difference
  • Modified Japanese orthopaedic association scale
  • Neck disability index
  • Nurick grade
  • Outcomes

ASJC Scopus subject areas

  • Clinical Neurology
  • Orthopedics and Sports Medicine

Fingerprint

Dive into the research topics of 'Surgical outcomes following laminectomy with fusion versus laminectomy alone in patients with degenerative cervical myelopathy'. Together they form a unique fingerprint.

Cite this