Early results of comparative study between Hemi-Laminectomy vs expansive-Laminoplasty for Cervical spondylotic myelopathy
Prasanna Gunasena, Anil Weerasinghe, Prabodha Samarathunga
Neurosurgical Unit Lanka Hospitals. Sri Lanka
Introduction
A prospective study to compare outcome between two different types of surgery, for Cervical Spondylotic Myelopathy. Both procedures aim to relieve pressure on the spinal cord and nerve roots caused by chronic degenerative changes with myelopathy..
Material and methods
Both procedures were done posteriorly. 33 patients were randomized to both procedures’ between Nov-2010 and Feb-2012. 19 patients were excluded from the study. 14 were analyzed. 10 patients underwent Unilateral Hemi-laminectomy and 4 had Expansive-laminoplasty, elevation and mini plate fixation done.
Result
Preoperative and postoperative assessment was done using the Japanese Orthopedic Association (JOA) cervical myelopathy evaluation questionnaire.
The mean time to follow up in the Hemi-laminectomy group was 9 months (range 3 – 12 months) and the Expansive-laminoplasty group was 6 months (range 3-10 months). In the Expansive-laminoplasty group, 66% of subjects (n=2) experienced deterioration of function whereas in the Hemi-laminectomy group 67% showed improvement in one or more aspects of functions assessed by the JOA questionnaire, 33% (n=3) had experienced deterioration only of one aspect.
Discussion and conclusion
The improvement of JOA score of hemi-laminectomy group was 6-55%. The Expansive-laminoplasty group showed only mild 5-11% of improvement in JOA score. Concludes that Hemi-laminectomy is far better in achieving good functional outcome. However a high loss to follow up rate weakens the findings. Study will continue.