TY - JOUR
T1 - Surgical outcomes following laminectomy with fusion versus laminectomy alone in patients with degenerative cervical myelopathy
AU - Kotter, Mark R.N.
AU - Tetreault, Lindsay
AU - Badhiwala, Jetan H.
AU - Wilson, Jefferson R.
AU - Arnold, Paul M.
AU - Bartels, Ronald
AU - Barbagallo, Giuseppe
AU - Kopiar, Branko
AU - Fehlings, Michael G.
N1 - Publisher Copyright:
© 2020 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2020/12/15
Y1 - 2020/12/15
N2 - 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.
AB - 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.
KW - Cervical spinal stenosis
KW - Degenerative cervical myelopathy
KW - Laminectomy
KW - Laminectomy and instrumented fusion
KW - Length of hospital stay
KW - Minimum clinically important difference
KW - Modified Japanese orthopaedic association scale
KW - Neck disability index
KW - Nurick grade
KW - Outcomes
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U2 - 10.1097/BRS.0000000000003677
DO - 10.1097/BRS.0000000000003677
M3 - Article
C2 - 32890295
AN - SCOPUS:85096815700
SN - 0362-2436
VL - 45
SP - 1696
EP - 1703
JO - Spine
JF - Spine
IS - 24
ER -