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Corpectomy versus laminoplasty for multilevel cervical myelopathy: an independent matched-cohort analysis.
Spine (Phila Pa 1976). 2002 Jun 01; 27(11):1168-75.S

Abstract

STUDY DESIGN

Matched patient cohorts using retrospective chart and radiographic review with independent clinical and radiographic follow-up were reviewed.

OBJECTIVE

To compare the clinical and radiographic outcomes of multilevel corpectomy and laminoplasty using an independent matched-cohort analysis.

SUMMARY OF BACKGROUND DATA

The treatment of choice for multilevel cervical myelopathy remains a matter of investigation. For the decompression of three or more motion segments, multilevel corpectomy and laminoplasty have proven effective while avoiding the pitfalls of laminectomy. Direct clinical comparisons of these two procedures are few in number and are limited by the heterogeneity in their patient groups.

METHODS

Medical records of all patients treated for multilevel cervical myelopathy with either multilevel corpectomy or laminoplasty between 1994 and 1999 at the Emory Spine Center were reviewed. From a pool of 38 patients meeting stringent inclusion and exclusion criteria, 13 patients who underwent multilevel corpectomy were blindly matched with 13 patients who underwent laminoplasty based on known prognostic criteria. A single physician independently evaluated each patient and their radiographs at their latest follow-up appointment.

RESULTS

The cohorts were well matched by age, duration of symptoms, severity of myelopathy (Nurick grade), and preoperative sagittal alignment (C2-C7). Mean operative time, blood loss, and hospital stay were nearly identical. The mean follow-up for multilevel corpectomy and laminoplasty were 49 and 40 months, respectively. Improvement in function averaged 1.6 Nurick grades after laminoplasty and 0.9 grades after multilevel corpectomy (P > 0.05). Subjective improvements in strength, dexterity, sensation, pain, and gait were similar for the two operations. The prevalence of axial discomfort at the latest follow-up was the same for each cohort, but the analgesic requirements tended to be greater for patients who underwent multilevel corpectomy. Sagittal motion from C2 to C7 decreased by 57% after multilevel corpectomy and by 38% after laminoplasty. One complication (C6-C7 herniated nucleus pulposus [HNP] requiring anterior discetomy with fusion) occurred in the laminoplasty group. Multilevel corpectomy complications included progression of myelopathy, nonunion, persistent dysphagia, persistent dysphonia, and subjacent motion segment ankylosis.

CONCLUSIONS

Both multilevel corpectomy and laminoplasty reliably arrest myelopathic progression in multilevel cervical myelopathy and can lead to significant neurologic recovery and pain reduction in a majority of patients. Surprisingly, the laminoplasty cohort tended to require less pain medication at final follow-up than did the multilevel corpectomy cohort. Given this and the higher prevalence of complications among multilevel corpectomy patients, it is believed that laminoplasty may be the preferred method of treatment for multilevel cervical myelopathy in the absence of preoperative kyphosis.

Authors+Show Affiliations

Emory Spine Center, Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia.No affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

12045513

Citation

Edwards, Charles C., et al. "Corpectomy Versus Laminoplasty for Multilevel Cervical Myelopathy: an Independent Matched-cohort Analysis." Spine, vol. 27, no. 11, 2002, pp. 1168-75.
Edwards CC, Heller JG, Murakami H. Corpectomy versus laminoplasty for multilevel cervical myelopathy: an independent matched-cohort analysis. Spine (Phila Pa 1976). 2002;27(11):1168-75.
Edwards, C. C., Heller, J. G., & Murakami, H. (2002). Corpectomy versus laminoplasty for multilevel cervical myelopathy: an independent matched-cohort analysis. Spine, 27(11), 1168-75.
Edwards CC, Heller JG, Murakami H. Corpectomy Versus Laminoplasty for Multilevel Cervical Myelopathy: an Independent Matched-cohort Analysis. Spine (Phila Pa 1976). 2002 Jun 1;27(11):1168-75. PubMed PMID: 12045513.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Corpectomy versus laminoplasty for multilevel cervical myelopathy: an independent matched-cohort analysis. AU - Edwards,Charles C,2nd AU - Heller,John G, AU - Murakami,Hideki, PY - 2002/6/5/pubmed PY - 2002/6/29/medline PY - 2002/6/5/entrez SP - 1168 EP - 75 JF - Spine JO - Spine (Phila Pa 1976) VL - 27 IS - 11 N2 - STUDY DESIGN: Matched patient cohorts using retrospective chart and radiographic review with independent clinical and radiographic follow-up were reviewed. OBJECTIVE: To compare the clinical and radiographic outcomes of multilevel corpectomy and laminoplasty using an independent matched-cohort analysis. SUMMARY OF BACKGROUND DATA: The treatment of choice for multilevel cervical myelopathy remains a matter of investigation. For the decompression of three or more motion segments, multilevel corpectomy and laminoplasty have proven effective while avoiding the pitfalls of laminectomy. Direct clinical comparisons of these two procedures are few in number and are limited by the heterogeneity in their patient groups. METHODS: Medical records of all patients treated for multilevel cervical myelopathy with either multilevel corpectomy or laminoplasty between 1994 and 1999 at the Emory Spine Center were reviewed. From a pool of 38 patients meeting stringent inclusion and exclusion criteria, 13 patients who underwent multilevel corpectomy were blindly matched with 13 patients who underwent laminoplasty based on known prognostic criteria. A single physician independently evaluated each patient and their radiographs at their latest follow-up appointment. RESULTS: The cohorts were well matched by age, duration of symptoms, severity of myelopathy (Nurick grade), and preoperative sagittal alignment (C2-C7). Mean operative time, blood loss, and hospital stay were nearly identical. The mean follow-up for multilevel corpectomy and laminoplasty were 49 and 40 months, respectively. Improvement in function averaged 1.6 Nurick grades after laminoplasty and 0.9 grades after multilevel corpectomy (P > 0.05). Subjective improvements in strength, dexterity, sensation, pain, and gait were similar for the two operations. The prevalence of axial discomfort at the latest follow-up was the same for each cohort, but the analgesic requirements tended to be greater for patients who underwent multilevel corpectomy. Sagittal motion from C2 to C7 decreased by 57% after multilevel corpectomy and by 38% after laminoplasty. One complication (C6-C7 herniated nucleus pulposus [HNP] requiring anterior discetomy with fusion) occurred in the laminoplasty group. Multilevel corpectomy complications included progression of myelopathy, nonunion, persistent dysphagia, persistent dysphonia, and subjacent motion segment ankylosis. CONCLUSIONS: Both multilevel corpectomy and laminoplasty reliably arrest myelopathic progression in multilevel cervical myelopathy and can lead to significant neurologic recovery and pain reduction in a majority of patients. Surprisingly, the laminoplasty cohort tended to require less pain medication at final follow-up than did the multilevel corpectomy cohort. Given this and the higher prevalence of complications among multilevel corpectomy patients, it is believed that laminoplasty may be the preferred method of treatment for multilevel cervical myelopathy in the absence of preoperative kyphosis. SN - 1528-1159 UR - https://www.unboundmedicine.com/medline/citation/12045513/Corpectomy_versus_laminoplasty_for_multilevel_cervical_myelopathy:_an_independent_matched_cohort_analysis_ L2 - https://doi.org/10.1097/00007632-200206010-00007 DB - PRIME DP - Unbound Medicine ER -