Post operative outcomes of surgery for cervical spondylotic myelopathy (csm): a comparative study between two different procedures – laminectomy vs. Laminoplasty

Authors – Prasanna Gunasena, Anil Weerasingha, SAPM Samarathunga

Abstract

Introduction

We conducted a retrospective cohort study to determine if there are differences in important clinical outcomes between patients who underwent two different types of surgery for the treatment of Cervical Spondylotic Myelopathy (CSM). Both procedures aim to relieve pressure on the spinal cord and nerve roots caused by chronic degenerative changes that affect the vertebral bodies, intervertebral discs, spinal canal, facet joints and ligaments via a posterior cervical approach.

Material and methods

Thirty three patients underwent the above procedures for treatment of CSM between November 2010 and February 2012. Twelve patients were analyzed (67% unavailable for follow up). One group (9 patients) received a Laminectomy/Hemi-Laminectomy and the other group (3 patients) received a Laminoplasty. Preoperative and postoperative clinical condition with regard to cervical spine, upper limb, lower limb and bladder/bowel function was assessed using the Japanese Orthopedic Association (JOA) cervical myelopathy evaluation questionnaire.

Results

The mean time to follow up in the laminectomy group was 9 months (range 3 – 12 months) and the laminoplasty group was 6 months (range 3-10 months). In the laminoplasty group, 66% of subjects (n=2) experienced deterioration of cervical spinal function following surgery whereas in the laminectomy group 33% remained at the same level of functionality preoperatively. All patients who underwent laminectomy showed improvement in one or more aspects of functions assessed by the JOA questionnaire (ranging from 6 -55%) while 33% (n=3) had experienced deterioration of one aspect. Compared to the laminectomy group the laminoplasty group showed only mild improvements in upper limb and lower limb functions following surgery (ranging from 5 – 9%).

Discussion and conclusions