Comparison of posterior approach surgical techniques for cervical spondylotic myelopathy: laminectomy with fusion, laminoplasty, and laminoplasty with fusion.

Abstract

Laminectomy with fusion (LF), laminoplasty (LP), and laminoplasty with fusion (LPF) are three techniques for posterior cervical decompression. LF can provide stability, but postoperative dural membrane adhesion and fusion failure can occur. LP can prevent postoperative dural membrane adhesion, but it can lead to kyphotic change. To address the disadvantages and further enhance the strengths of each, the LPF technique can be a good option. This study aimed to confirm whether LPF can overcome the disadvantages of LF and LP. Single-center, retrospective cohort study. Twenty patients for each technique were randomly selected. Δ C2-7 sagittal vertical axis (SVA), Δ T1 slope, Δ C2-7 Cobb's angle, Δ spinal canal length, and fusion success rate were measured for radiologic outcomes. Preoperative and postoperative Japanese Orthopedic Association (JOA) scores and recovery rates (RRs) were measured for clinical outcomes. Patients who underwent LF, LP, or LPF between 2012 and 2023 were enrolled, and 20 patients for each technique were randomly selected. Δ C2-7 sagittal vertical axis (SVA), Δ T1 slope, Δ C2-7 Cobb's angle, Δ spinal canal length, fusion success rate, complications, operation time, blood loss, JOA scores, visual analog scale (VAS) scores, and RRs were measured. Δ C2-7 Cobb's angle (LPF, -2.62±5.0; LP, -6.43±4.9; p=.020) and Δ C2-7 SVA (LPF, 6.48±8.3; LP, 13.84±9.9; p=.015) were significantly different between LPF and LP. No significant changes in Δ spinal canal length between LPF and LP were observed (LPF, 2.93±1.3; LP, 3.05±1.5; p=.780). The fusion success rate with LPF was higher than that with LF (LPF, 80.0%; LF, 45.0%; p=.027). The JOA RR was the highest with LPF (LPF, 49.96%±24.7; LF, 31.70%±27.8; LP, 29.31%±30.8, p=.045). LPF can overcome the disadvantages of LF and LP while retaining their benefits.