Cervical Laminectomy With or Without Lateral Mass Instrumentation: A Comparison of Outcomes.Clin Spine Surg 2019; 32(6):226-232CS
Cervical decompressive laminectomy is a common posterior approach for addressing multilevel cervical spondylotic myelopathy. However, there is a concern that cervical laminectomy can lead to kyphotic deformity with subsequent neurological decline. In this context, cervical laminectomy with fusion using lateral mass instrumentation has become increasingly utilized with the aim of reducing the risk of developing postoperative kyphotic deformity, which is thought to predispose to poorer neurological outcomes in the long term.
To compare the evidence for stand-alone cervical laminectomy with laminectomy with posterior fusion in terms of clinical outcomes and the incidence of adverse events, particularly the development of postoperative cervical kyphosis.
MATERIAL AND METHODS
Initial Medline search using MeSH terms yielded 226 articles, 23 of which were selected. An additional PubMed search and the reference list of individual papers were utilized to identify the remaining papers of relevance.
Cervical laminectomy both with and without fusion offers effective decompression for symptomatic multilevel cervical spondylotic myelopathy. The incidence of postlaminectomy kyphosis is lower following posterior fusion; however, there seems to be no clinical-radiologic correlation given that patients who develop postoperative kyphosis often do not progress to clinical myelopathy. Furthermore, there are specific additional risks of posterior instrumentation that need to be considered.
In carefully selected patients with normal preoperative cervical sagittal alignment, stand-alone cervical laminectomy may offer acceptably low rates of postoperative kyphosis. In patients with preoperative loss of cervical lordosis and/or kyphosis, posterior fusion is recommended to reduce the risk of progression to postoperative kyphotic deformity, bearing in mind that radiologic evidence of kyphosis may not necessarily correlate with poorer clinical outcomes. Furthermore, the specific risks associated with posterior fusion (instrumentation failure, pseudarthrosis, infection, C5 nerve root palsy, and vertebral artery injury) need to be considered and weighed up against potential benefits.