Expansion Open-door Laminoplasty With Foraminotomy Versus Anterior Cervical Discectomy and Fusion for Coexisting Multilevel Cervical Myelopathy and Unilateral Radiculopathy.

Abstract

This was a clinical prospective study. To assess whether clinical and radiologic outcomes differ between expansion open-door laminoplasty with foraminotomy (EOLF) and anterior cervical discectomy and fusion (ACDF) in the treatment of coexisting multilevel cervical myelopathy and unilateral radiculopathy (CMUR). No reports to date have compared clinical outcomes between anterior and posterior decompression for CMUR. We prospectively performed ACDF (n=59) in 2004, 2006, and 2008 and EOLF (n=62) in 2005, 2007, and 2009. The Japanese Orthopedic Association (JOA) score and recovery rate were evaluated. For radiographic evaluation, the lordotic angle and range of motion at C2-C7 were investigated. Only 110 patients could be followed for >3 years (EOLF/ACDF: 56/54; follow-up rate, 90.9%). Demographics were similar between the 2 groups. Compared with ACDF, in EOLF group there were shorter operating time (144 vs. 178 min), less bleeding (175 vs. 192 mL), and fewer complications (P<0.05). Results of JOA score and recovery rate, at 3-year postoperative follow-up, showed no statistical difference for the 2 groups. Cervical lordosis of ACDF increased from 13.7 to 16.2 degrees, whereas that of EOLF group decreased from 14.6 to 13.3 degrees (P<0.05). The percentage of range of motion declined in the 2 groups (ACDF/EOLF), 57.4% versus 74.7% (P<0.05). The 2 surgical procedures have similar clinical effects in treating multisegmental CMUR. However, the EOLF group demonstrated shorter operative time, less blood loss, and fewer complications; therefore, it proved to be a more effective and safer method.