A Comparison of Clinical Outcomes Between Anterior Cervical Discectomy and Fusion Versus Posterior Cervical Laminoplasty for Multilevel Cervical Myelopathy.

Authors

• Yunsoo Lee
• Delano Trenchfield
• Emily Berthiaume
• Alexa Tomlak
• Rajkishen Narayanan
• Parker Brush
• Jeremy Heard
• Krisna Maddy
• Tariq Issa
• Mark Lambrechts
• Ian David Kaye
• John Mangan
• Giovanni Grasso
• Jose Canseco
• Alexander Vaccaro
• Christopher Kepler
• Gregory Schroeder
• Alan Hilibrand

Publication/Presentation Date

12-1-2024

Abstract

STUDY DESIGN: Retrospective Cohort.

OBJECTIVE: To compare patient-reported outcomes and surgical outcomes after anterior cervical discectomy and fusion (ACDF) versus cervical laminoplasty for multilevel cervical spondylotic myelopathy.

BACKGROUND: Treatment options for multilevel cervical spondylotic myelopathy include ACDF and cervical laminoplasty. Given that the literature has been mixed regarding the optimal approach, especially in patients without kyphosis, there is a need for additional studies investigating outcomes between ACDF and cervical laminoplasty.

METHODS: A retrospective review was conducted of adult patients undergoing 3 or 4-level surgery. Patients with preoperative kyphosis based on C2-C7 Cobb angles were excluded. The electronic medical record and institutional databases were reviewed for baseline characteristics, surgical outcomes, and patient-reported outcomes.

RESULTS: A total of 101 patients who underwent ACDF and 52 patients who underwent laminoplasty were included in the study. The laminoplasty cohort had a higher overall Charlson Comorbidity Index (3.10 ± 1.43 vs 2.39 ± 1.57, P = 0.011). Both groups had a comparable number of levels decompressed, C2-C7 lordosis, and diagnosis of myelopathy versus myeloradiculopathy. Patients who underwent laminoplasty had a longer length of stay (2.04 ± 1.15 vs 1.48 ± 0.70, P = 0.003) but readmission, complication, and revision rates were similar. Both groups had similar improvement in myelopathy scores (∆modified Japanese Orthopedic Association: 1.11 ± 3.09 vs 1.06 ± 3.37, P = 0.639). ACDF had greater improvement in Neck Disability Index (∆Neck Disability Index: -11.66 ± 19.2 vs -1.13 ± 11.2, P < 0.001), neck pain (∆Visual Analog Scale-neck: -2.69 ± 2.78 vs -0.83 ± 2.55, P = 0.003), and arm pain (∆Visual Analog Scale-arm: -2.47 ± 3.15 vs -0.48 ± 3.19, P = 0.010). These findings persisted in multivariate analysis except for Neck Disability Index.

CONCLUSION: ACDF and cervical laminoplasty appear equally efficacious at halting myelopathic progression. However, patients who underwent ACDF had greater improvements in arm pain at 1 year postoperatively. Longitudinal studies evaluating the efficacy of laminoplasty to mitigate adjacent segment disease are indicated to establish a robust risk-benefit assessment for these 2 procedures.

LEVEL OF EVIDENCE: III.

Volume

37

Issue

10

First Page

529

Last Page

529

ISSN

2380-0194

Published In/Presented At

Lee, Y., Trenchfield, D., Berthiaume, E., Tomlak, A., Narayanan, R., Brush, P., Heard, J., Maddy, K., Issa, T., Lambrechts, M., Kaye, I. D., Mangan, J., Grasso, G., Canseco, J., Vaccaro, A., Kepler, C., Schroeder, G., & Hilibrand, A. (2024). A Comparison of Clinical Outcomes Between Anterior Cervical Discectomy and Fusion Versus Posterior Cervical Laminoplasty for Multilevel Cervical Myelopathy. Clinical spine surgery, 37(10), E529–E535. https://doi.org/10.1097/BSD.0000000000001634

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

38884360

Department(s)

Administration and Leadership

Document Type

Article