The efficacy of posterior cervical laminectomy for multilevel degenerative cervical spondylotic myelopathy in long term period

Neilakuo Kire; Sanyam Jain; Zahir Merchant; Vishal Kundnani

doi:10.4103/ajns.AJNS_49_19

Asian Journal of Neurosurgery, Table of Contents

CC BY-NC-ND 4.0 · Asian J Neurosurg 2019; 14(03): 848-852
DOI: 10.4103/ajns.AJNS_49_19

Original Article

The efficacy of posterior cervical laminectomy for multilevel degenerative cervical spondylotic myelopathy in long term period

Neilakuo Kire

Spine Unit, Department of Orthopeadics, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra

,

Sanyam Jain

Spine Unit, Department of Orthopeadics, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra

,

Zahir Merchant

Spine Unit, Department of Orthopeadics, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra

,

Vishal Kundnani

Spine Unit, Department of Orthopeadics, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra

› Author Affiliations

Abstract

Study Design: This was a retrospective analysis. Background: Surgical decompression is the gold standard for preventing the progression of neurological deficit in degenerative multilevel cervical spondylotic myelopathy (CSM). The efficacy of posterior laminectomy in the surgical management of CSM has been described in the past, but long-term follow-up data are scanty. Objective: The aim of this study is to assess the long-term clinical-radiological outcomes following posterior cervical decompressive laminectomy in multilevel degenerative CSM. Materials and Methods: A retrospective analysis of 110 patients with degenerative multilevel CSM who underwent posterior cervical laminectomy alone in a single hospital by a single surgeon from 2009 to 2013 with minimum 5-year follow-up. Pre- and post-operative clinical parameters (visual analog scale [VAS], Nurick and modified Japanese orthopedic association [mJOA]), radiological parameter (Sagittal cervical Cobb's Angle), perioperative complications (time, blood loss, and hospital stay), postoperative complications (infection, C5 palsy, and neurological worsening) were evaluated. Results: Totally 110 patients (males – 68 and females – 42) with age varying from 46 to 80 (mean-57) years, and the mean duration of illness was 3 months were evaluated. Mean clinical parameters are VAS (preoperative = 5 ± 1.31, postoperative = 1.49 ± 0.687), Nurick grading (preoperative = 3.23 ± 71, postoperative = 1.924 ± 0.75), and mJOA (preoperative = 6.32 ± 0.87, postoperative = 9.89 ± 1.37). The mean blood loss was 93.95 ± 19.18 ml, and the mean time taken for surgery was 83.65 ± 10.18 min. About 13% (n = 15) patients developed cervical kyphosis and 29% (n = 32) developed changes in cervical spine alignment and 10% (n = 11) developed worsening of neurology at final follow-up. Two patients developed a superficial infection which was managed with antibiotics. Three patients developed C5 palsy which recovered with due time. Conclusions: With the proper selection of patients, posterior cervical laminectomy is effective in offering a clinical improvement to patients with degenerative multilevel CSM with a low incidence of clinically significant radiological deterioration.

Key-words:

Cervical laminectomy - cervical spondylotic myelopathy - neurological recovery - surgical outcome

Full Text

References

References
1 Fehlings MG, Tetreault LA, Riew KD, Middleton JW, Wang JC. A clinical practice guideline for the management of degenerative cervical myelopathy: Introduction, rationale, and scope. Global Spine J 2017;7:21S-27S.
2 Kalsi-Ryan S, Karadimas SK, Fehlings MG. Cervical spondylotic myelopathy: The clinical phenomenon and the current pathobiology of an increasingly prevalent and devastating disorder. Neuroscientist 2013;19:409-21.
3 Fehlings MG, Tetreault LA, Wilson JR, Skelly AC. Cervical spondylotic myelopathy: Current state of the art and future directions. Spine (Phila Pa 1976) 2013;38:S1-8.
4 Shamji MF, Ames CP, Smith JS, Rhee JM, Chapman JR, Fehlings MG, et al. Myelopathy and spinal deformity: Relevance of spinal alignment in planning surgical intervention for degenerative cervical myelopathy. Spine (Phila Pa 1976) 2013;38:S147-8.
5 Nouri A, Tetreault L, Singh A, Karadimas SK, Fehlings MG. Degenerative cervical myelopathy: Epidemiology, genetics, and pathogenesis. Spine (Phila Pa 1976) 2015;40:E675-93.
6 Harris N, Grootjans J, Wenham K. Ecological aging: The settings approach in aged living and care accommodation. Ecohealth 2008;5:196-204.
7 Nakashima H, Tetreault LA, Nagoshi N, Nouri A, Kopjar B, Arnold PM, et al. Does age affect surgical outcomes in patients with degenerative cervical myelopathy? Results from the prospective multicenter AOSpine international study on 479 patients. J Neurol Neurosurg Psychiatry 2016;87:734-40.
8 Isogai N, Nagoshi N, Iwanami A, Kono H, Kobayashi Y, Tsuji T, et al. Surgical treatment of cervical spondylotic myelopathy in the elderly: Outcomes in patients aged 80 years or older. Spine (Phila Pa 1976) 2018;43:E1430-6.
9 Fehlings MG, Wilson JR, Kopjar B, Yoon ST, Arnold PM, Massicotte EM, et al. Efficacy and safety of surgical decompression in patients with cervical spondylotic myelopathy: Results of the AOSpine North America prospective multi-center study. J Bone Joint Surg Am 2013;95:1651-8.
10 Hirabayashi K, Miyakawa J, Satomi K, Maruyama T, Wakano K. Operative results and postoperative progression of ossification among patients with ossification of cervical posterior longitudinal ligament. Spine (Phila Pa 1976) 1981;6:354-64.
11 Shiraishi T, Kato M, Yato Y, Ueda S, Aoyama R, Yamane J, et al. New techniques for exposure of posterior cervical spine through intermuscular planes and their surgical application. Spine (Phila Pa 1976) 2012;37:E286-96.
12 Seichi A, Takeshita K, Ohishi I, Kawaguchi H, Akune T, Anamizu Y, et al. Long-term results of double-door laminoplasty for cervical stenotic myelopathy. Spine (Phila Pa 1976) 2001;26:479-87.
13 Chen J, Liu Z, Zhong G, Qian L, Li Z, Chen B, et al. Surgical treatment for cervical spondylotic myelopathy in elderly patients: A retrospective study. Clin Neurol Neurosurg 2015;132:47-51.
14 Handa Y, Kubota T, Ishii H, Sato K, Tsuchida A, Arai Y, et al. Evaluation of prognostic factors and clinical outcome in elderly patients in whom expansive laminoplasty is performed for cervical myelopathy due to multisegmental spondylotic canal stenosis. A retrospective comparison with younger patients. J Neurosurg 2002;96:173-9.
15 Kawaguchi Y, Kanamori M, Ishihara H, Ohmori K, Abe Y, Kimura T, et al. Pathomechanism of myelopathy and surgical results of laminoplasty in elderly patients with cervical spondylosis. Spine (Phila Pa 1976) 2003;28:2209-14.
16 Machino M, Yukawa Y, Imagama S, Ito K, Katayama Y, Matsumoto T, et al. Surgical treatment assessment of cervical laminoplasty using quantitative performance evaluation in elderly patients: A prospective comparative study in 505 patients with cervical spondylotic myelopathy. Spine (Phila Pa 1976) 2016;41:757-63.
17 Son DK, Son DW, Song GS, Lee SW. Effectiveness of the laminoplasty in the elderly patients with cervical spondylotic myelopathy. Korean J Spine 2014;11:39-44.
18 Tanaka J, Seki N, Tokimura F, Doi K, Inoue S. Operative results of canal-expansive laminoplasty for cervical spondylotic myelopathy in elderly patients. Spine (Phila Pa 1976) 1999;24:2308-12.
19 Puvanesarajah V, Jain A, Shimer AL, Li X, Singla A, Shen F, et al. Complications and mortality following 1 to 2 level lumbar fusion surgery in patients above 80 years of age. Spine (Phila Pa 1976) 2017;42:437-41.
20 Hayashi K, Matsumura A, Konishi S, Kato M, Namikawa T, Nakamura H, et al. Clinical outcomes of posterior lumbar interbody fusion for patients 80 years of age and older with lumbar degenerative disease: Minimum 2 years' follow-up. Global Spine J 2016;6:665-72.
21 Puvanesarajah V, Jain A, Shimer AL, Singla A, Shen F, Hassanzadeh H, et al. Complications and mortality following one to two-level anterior cervical fusion for cervical spondylosis in patients above 80 years of age. Spine (Phila Pa 1976) 2017;42:E509-14.
22 Guidetti B, Fortuna A. Long-term results of surgical treatment of myelopathy due to cervical spondylosis. J Neurosurg 1969;30:714-21.
23 Hsu L. Cervical myelopathy: Overview and management. J Pain Palliat Care Pharmacother 2012;26:371-2.
24 Hamanishi C, Tanaka S. Bilateral multilevel laminectomy with or without posterolateral fusion for cervical spondylotic myelopathy: Relationship to type of onset and time until operation. J Neurosurg 1996;85:447-51.
25 Lad SP, Babu R, Ugiliweneza B, Patil CG, Boakye M. Surgery for spinal stenosis: Long-term reoperation rates, health care cost, and impact of instrumentation. Spine (Phila Pa 1976) 2014;39:978-87.
26 McAllister BD, Rebholz BJ, Wang JC. Is posterior fusion necessary with laminectomy in the cervical spine? Surg Neurol Int 2012;3:S225-31.
27 Ryken TC, Heary RF, Matz PG, Anderson PA, Groff MW, Holly LT. Cervical laminectomy for the treatment of cervical degenerative myelopathy. J Neurosurg Spine 2009;11:142-9.
28 Kaptain GJ, Simmons NE, Replogle RE, Pobereskin L. Incidence and outcome of kyphotic deformity following laminectomy for cervical spondylotic myelopathy. J Neurosurg 2000;93:199-204.
29 van Geest S, de Vormer AM, Arts MP, Peul WC, Vleggeert-Lankamp CL. Long-term follow-up of clinical and radiological outcome after cervical laminectomy. Eur Spine J 2015;24 Suppl 2:229-35.
30 Bartels RH, Groenewoud H, Peul WC, Arts MP. Lamifuse: Results of a randomized controlled trial comparing laminectomy with and without fusion for cervical spondylotic myelopathy. J Neurosurg Sci 2017;61:134-9.
31 Du W, Wang L, Shen Y, Zhang Y, Ding W, Ren L, et al. Long-term impacts of different posterior operations on curvature, neurological recovery and axial symptoms for multilevel cervical degenerative myelopathy. Eur Spine J 2013;22:1594-602.
32 Heller JG, Edwards CC 2nd, Murakami H, Rodts GE. Laminoplasty versus laminectomy and fusion for multilevel cervical myelopathy: An independent matched cohort analysis. Spine (Phila Pa 1976) 2001;26:1330-6.
33 Woods BI, Hohl J, Lee J, Donaldson W 3rd, Kang J. Laminoplasty versus laminectomy and fusion for multilevel cervical spondylotic myelopathy. Clin Orthop Relat Res 2011;469:688-95.