Meta-analysis of posterior laminectomy and instrumented fusion versus laminoplasty in treatment of multilevel cervical spondylotic myelopathy

doi:10.3969/j.issn.2095-4344.2017.03.028

Abstract

Abstract:

BACKGROUND: Many studies concern the comparison of posterior laminectomy and instrumented fusion and posterior laminoplasty for multilevel cervical spondylotic myelopathy, but the sample size of many studies has limitations. There is lack of objective evaluation on advantages and disadvantages of two surgical methods.

OBJECTIVE: To compare the efficacy and safety of posterior laminectomy and instrumented fusion and laminoplasty in the treatment of multilevel cervical spondylotic myelopathy.

METHODS: A systematic search of all the studies published was conducted on the PubMed, Cochrane Central, EMbase, the ISI Web of Knowledge Database, CMB, CNKI, VIP and Wanfang databases. Randomized and non-randomized controlled trials that compared between posterior laminectomy and instrumented fusion and laminoplasty for multilevel cervical spondylotic myelopathy were identified. Meta-analyses were performed in postoperative Japanese Orthopaedic Association scores, cervical range of motion, cervical curvature index, incidence of C₅nerve root paralysis and incidence of axial symptoms.

RESULTS AND CONCLUSION: (1) Fourteen studies involving 1 024 patients were included. Among the patients, 519 underwent laminectomy and instrumented fusion and 505 underwent laminoplasty. (2) The results of the meta-analysis indicated that, compared with laminectomy and instrumented fusion group, laminoplasty group had advantages of a lower incidence of C₅ palsy [RR=2.24, 95%CI(1.33，3.75), Z=3.05, P < 0.05] and small degree of cervical rotation injury [SMD=-0.71, 95%CI(-2.21，-1.2), Z=6.63, P < 0.05]. However, the two groups had no statistical difference in postoperative Japanese Orthopaedic Association score, cervical curvature index and the incidence of axial symptoms. (3) These results suggested that both laminectomy and instrumented fusion and laminoplasty were demonstrated to be effective for multilevel cervical spondylotic myelopathy. Laminoplasty had obvious advantages of decreasing the degree of cervical rotation injury and lowering incidence of C₅ palsy. However, in the process of clinical diagnosis and treatment, the patient’s condition should be combined. The long-term clinical efficacy of the technology needs more clinical work to confirm.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Cervical spondylotic, Meta-Analysis, Tissue Engineering

CLC Number:

R318

Zha Yuan-yu, Yang Yang, Chen Shu-zhen, Wei Ren-xiong, Zhang Shu-wei, Jin Wei. Meta-analysis of posterior laminectomy and instrumented fusion versus laminoplasty in treatment of multilevel cervical spondylotic myelopathy[J]. Chinese Journal of Tissue Engineering Research, 2017, 21(3): 485-492.

Figures/Tables 3

References

[1] Karadimas SK，Gatzounis G,Fehlings MG.Pathobiology of cervical spondylotic myelopathy.Eur Spine J.2015;24(2): 132-138.

[2] Wells GA,Shea BJ,O'Connell D,et al.The Newcastle- Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. Appl Eng Agric. 2002;18(6):727-734.

[3] Zhang H,Sun T,Shouliang LU,et al.Comparison of effectiveness between laminoplasty and laminectomy decompression and fusion with internal fixation for cervical spondylotic myelopathy. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2012;26(10):1191-1196.

[4] Lee CH,Jahng TA,Hyun SJ,et al.Expansive Laminoplasty Versus Laminectomy Alone Versus Laminectomy and Fusion for Cervical Ossification of the Posterior Longitudinal Ligament: Is There a Difference in the Clinical Outcome and Sagittal Alignment? Clin Spine Surg.2016; 29(1):E9-15.

[5] Heller JG,Murakami H,Rodts GE.Laminoplasty versus laminectomy and fusion for multilevel cervical myelopathy: an independent matched cohort analysis.Spine(Phila Pa 1976). 2001;26(12): 1330-1336.

[6] Woods BI,Hohl J,Lee J,et al.Laminoplasty versus Laminectomy and Fusion for Multilevel Cervical Spondylotic Myelopathy.Clin Orthop Relat Res.2011; 469(3):688-695.

[7] Du W,Wang L,Shen Y,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(7):1594-1602.

[8] Yang L,Gu Y,Shi J,et al. Modified Plate-only Open-door Laminoplasty Versus Laminectomy and Fusion for the Treatment of Cervical Stenotic Myelopathy. Orthopedics. 2013;36(36):e79-87.

[9] Wei Y,Yue Z,Liu X,et al.Postoperative three-dimensional cervical range of motion and neurological outcomes in patients with cervical ossification of the posterior longitudinal ligament: Cervical laminoplasty versus laminectomy with fusion.Clin Neurol Neurosurg.2015; 134:17-23.

[10] Chen Y,Liu X,Chen D,et al.Surgical strategy for ossification of the posterior longitudinal ligament in the cervical spine. Orthopedics.2012;35(8): 1231-1237.

[11] Highsmith JM,Dhall SS,Haid RW,et al.Treatment of cervical stenotic myelopathy: a cost and, outcome comparison of laminoplasty versus laminectomy, and lateral mass fusion.J Neurosurg Spine.2011;14(5):619-625.

[12] Manzano GR,Casella G,Wang MY,et al.A prospective, randomized trial comparing expansile cervical laminoplasty and cervical laminectomy and fusion for multilevel cervical myelopathy.Neurosurgery.2012;70(2):264-277.

[13] Koda M,Mochizuki M,Konishi H,et al.Comparison of clinical outcomes between laminoplasty, posterior decompression with instrumented fusion, and anterior decompression with fusion for K-line (–) cervical ossification of the posterior longitudinal ligament.Eur Spine J.2016;25(7):2294-2301.

[14] 刘晓伟,陈德玉,王新伟,等.颈椎后纵韧带骨化症患者K线对两种颈后路手术疗效的影响[J].中国脊柱脊髓杂志,2013, 23(1): 6-10.

[15] 王辉,丁文元,申勇,等.颈椎后纵韧带骨化症间接减压术后轴性症状分析[J].中华外科杂志,2012,50(7):601-606

[16] 李亮,燕树义,于学忠,等.两种颈后路术式对颈椎曲度及椎间高度的中期影响[J].中国矫形外科杂志,2013,21(19): 1929-1936.

[17] Yukawa Y,Kato F,Ito K,et al.Laminoplasty and skip laminectomy for cervical compressive myelopathy: range of motion, postoperative neck pain, and surgical outcomes in a randomized prospective study.Spine(Phila Pa 1976).2007; 32(18):1980-1985.

[18] Park YS,Nakase H,Kawaguchi S,et al.Predictors of outcome of surgery for cervical compressive myelopathy: retrospective analysis and prospective study.Neurol Med Chir.2006;46(5):231-238.

[19] 侯增涛,赵爱琳,郭传友,等.多节段脊髓型颈椎病治疗方式选择与疗效评价[J].中国组织工程研究,2014,18(40): 6444-6450.

[20] 胡孔和,吴强,靳安民,等.颈椎单开门OsteoMed M3钉板内固定椎管扩大成形术螺钉进钉点的解剖学CT测量[J].中国矫形外科杂志,2012,20(24):2272-2275.

[21] 安忠诚,曹瑞,盛伟斌,等.保留双侧半棘肌改良单开门椎管扩大钢板置入:减少轴性症状及颈椎曲度丢失[J].中国组织工程研究,2016,20(13):1873-1879.

[22] Kim B,Yoon DH,Shin HC,et al.Surgical outcome and prognostic factors of anterior decompression and fusion for cervical compressive myelopathy due to ossification of the posterior longitudinal ligament.Spine J.2015;15(5):875-884.

[23] 翟吉良,翁习生,胡建华.颈椎减压术后C5神经根麻痹的研究进展[J].中国脊柱脊髓杂志,2014,24(1):73-76.

[24] 王新伟,袁文,陈德玉,等.颈椎后纵韧带骨化症的手术方式选择及疗效[J].中华外科杂志,2012,50(7):596-600.

[25] 周非非,孙宇,张凤山,等.颈椎前路椎间盘切除、植骨融合内固定术治疗脊髓型颈椎病术后轴性症状的前瞻性研究[J].中国脊柱脊髓杂志,2014,24(6):505-509.

[26] Sakaura H,Hosono N,Mukai Y,et al.Preservation of muscles attached to the C2 and C7 spinous processes rather than subaxial deep extensors reduces adverse effects after cervical laminoplasty.Spine(Phila Pa 1976).2010;35(35): 782-786.

[27] 张为,李鹏飞,申勇,等.颈后路三种手术方法对颈椎曲度及轴性症状的长期影响[J].中国矫形外科杂志, 2011,19(9):709-712.

[28] Schulz KF,Moher D,Altman DG.CONSORT 2010 comments.Lancet.2010; 376(9748):1222-1223.