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Operative treatment of cervical spondylotic myelopathy and radiculopathy. A comparison of laminectomy and laminoplasty at five year average follow-up.
Iowa Orthop J. 2004; 24:95-105.IO

Abstract

BACKGROUND

The natural history of cervical spondylotic myelopathy is frequently one of slow, progressive neurological deterioration. The operative treatment for patients with moderate to severe involvement is decompression of the spinal cord. Laminectomy has been a traditional approach and laminoplasty has developed as an attractive alternative. The purpose of this study was to examine and compare the outcomes of these two procedures in similar groups of patients at a five year average follow-up.

METHODS

A consecutive series of twenty patients who underwent open-door laminoplasty for multi-level cervical spondylotic myelopathy or radiculopathy was compared to a similar group of 22 matched patients who underwent multi-level laminectomies. Patients were similar in age, gender, number of operative levels, and length of follow-up. At the latest examination, each patient underwent a comprehensive neurological evaluation. A modification of the Nurick classification was used to assess the degree of myelopathy. Radiographs at latest follow-up were assessed for instability, and measurements of the space-available-for-the-cord and Pavlov ratio were made at involved levels.

RESULTS

Myelopathy, as determined by our modified Nurick scale, improved from a preoperative average of 2.44 to 1.48 in laminoplasty patients and from an average of 3.09 to 2.50 in laminectomy patients. Pain improved 57 percent and 8 percent in laminoplasty and laminectomy groups, respectively. Subjective neck stiffness was not significantly different based on the numbers available, although laminoplasty patients demonstrated some loss of range of motion on examination. The only variable that predicted the postoperative degree of myelopathy in both groups was the preoperative degree of myelopathy.

CONCLUSIONS

Laminectomy and laminoplasty patients demonstrated improvements in gait, strength, sensation, pain, and degree of myelopathy. Laminoplasty was associated with fewer late complications. Based on this analysis, we believe that laminoplasty is an effective alternative to laminectomy in patients with multi-level cervical spondylotic myelopathy or radiculopathy.

Authors+Show Affiliations

Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA 52246, USA.No affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

15296214

Citation

Kaminsky, S B., et al. "Operative Treatment of Cervical Spondylotic Myelopathy and Radiculopathy. a Comparison of Laminectomy and Laminoplasty at Five Year Average Follow-up." The Iowa Orthopaedic Journal, vol. 24, 2004, pp. 95-105.
Kaminsky SB, Clark CR, Traynelis VC. Operative treatment of cervical spondylotic myelopathy and radiculopathy. A comparison of laminectomy and laminoplasty at five year average follow-up. Iowa Orthop J. 2004;24:95-105.
Kaminsky, S. B., Clark, C. R., & Traynelis, V. C. (2004). Operative treatment of cervical spondylotic myelopathy and radiculopathy. A comparison of laminectomy and laminoplasty at five year average follow-up. The Iowa Orthopaedic Journal, 24, 95-105.
Kaminsky SB, Clark CR, Traynelis VC. Operative Treatment of Cervical Spondylotic Myelopathy and Radiculopathy. a Comparison of Laminectomy and Laminoplasty at Five Year Average Follow-up. Iowa Orthop J. 2004;24:95-105. PubMed PMID: 15296214.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Operative treatment of cervical spondylotic myelopathy and radiculopathy. A comparison of laminectomy and laminoplasty at five year average follow-up. AU - Kaminsky,S B, AU - Clark,C R, AU - Traynelis,V C, PY - 2004/8/7/pubmed PY - 2004/8/25/medline PY - 2004/8/7/entrez SP - 95 EP - 105 JF - The Iowa orthopaedic journal JO - Iowa Orthop J VL - 24 N2 - BACKGROUND: The natural history of cervical spondylotic myelopathy is frequently one of slow, progressive neurological deterioration. The operative treatment for patients with moderate to severe involvement is decompression of the spinal cord. Laminectomy has been a traditional approach and laminoplasty has developed as an attractive alternative. The purpose of this study was to examine and compare the outcomes of these two procedures in similar groups of patients at a five year average follow-up. METHODS: A consecutive series of twenty patients who underwent open-door laminoplasty for multi-level cervical spondylotic myelopathy or radiculopathy was compared to a similar group of 22 matched patients who underwent multi-level laminectomies. Patients were similar in age, gender, number of operative levels, and length of follow-up. At the latest examination, each patient underwent a comprehensive neurological evaluation. A modification of the Nurick classification was used to assess the degree of myelopathy. Radiographs at latest follow-up were assessed for instability, and measurements of the space-available-for-the-cord and Pavlov ratio were made at involved levels. RESULTS: Myelopathy, as determined by our modified Nurick scale, improved from a preoperative average of 2.44 to 1.48 in laminoplasty patients and from an average of 3.09 to 2.50 in laminectomy patients. Pain improved 57 percent and 8 percent in laminoplasty and laminectomy groups, respectively. Subjective neck stiffness was not significantly different based on the numbers available, although laminoplasty patients demonstrated some loss of range of motion on examination. The only variable that predicted the postoperative degree of myelopathy in both groups was the preoperative degree of myelopathy. CONCLUSIONS: Laminectomy and laminoplasty patients demonstrated improvements in gait, strength, sensation, pain, and degree of myelopathy. Laminoplasty was associated with fewer late complications. Based on this analysis, we believe that laminoplasty is an effective alternative to laminectomy in patients with multi-level cervical spondylotic myelopathy or radiculopathy. SN - 1541-5457 UR - https://www.unboundmedicine.com/medline/citation/15296214/Operative_treatment_of_cervical_spondylotic_myelopathy_and_radiculopathy__A_comparison_of_laminectomy_and_laminoplasty_at_five_year_average_follow_up_ L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/15296214/ DB - PRIME DP - Unbound Medicine ER -