Surgical Outcomes in Selective Laminectomy and Conventional Double-Door Laminoplasty for Cervical Spondylotic Myelopathy.

Abstract

Several postoperative problems have been reported in conventional cervical laminoplasty (C-LAMP), such as loss of cervical curvature, sagittal imbalance, and loss of range of motion (ROM). Selective laminectomy (S-LAM) is a less invasive procedure that may prevent the problems associated with conventional C-LAMP. In this study, the authors prospectively compared neurological outcomes and radiological parameters in C-LAMP and S-LAM for the treatment of cervical spondylotic myelopathy. Fifty-three patients were enrolled, with 25 patients receiving conventional double-door C-LAMP and 28 patients receiving S-LAM. Measured outcomes included operative time, intraoperative blood loss, Japanese Orthopaedic Association score for neurological recovery, cervical sagittal alignment at C2-7, cervical sagittal vertical axis from occiput to C7, C7 slope, and cervical ROM at C2-7. No difference was found in operative time, whereas intraoperative blood loss was significantly less in the S-LAM group (P<.05). No significant difference in neurological recovery was found between the 2 groups. The postoperative C2-7 angle was significantly smaller (P<.05) and cervical sagittal vertical axis greater (P<.01) in the C-LAMP group. Postoperative ROM at C2-7 was greater (P<.01) in the S-LAM group. In the CLAMP group, postoperative kyphotic change was greater in patients with high C7 slope. However, in the S-LAM group, postoperative sagittal alignment was preserved even in patients with high C7 slope. Postoperative cervical alignment, sagittal balance, and cervical ROM were better preserved in the S-LAM group compared with the C-LAMP group. Selective laminectomy is an effective, minimally invasive method for cervical spondylotic myelopathy with spinal cord compression at limited levels. [Orthopedics. 2020;43(4);e311-e315.].