Published 12/1/2015
Maureen Leahy

Posterior Surgical Treatment Options for CSM

Study finds comparable results for laminectomy and fusion and laminoplasty

Laminectomy and fusion and laminoplasty for cervical spondylotic myelopathy (CSM) are associated with similar levels of myelopathy improvement in elderly patients at 1-year follow-up, according to study data presented at the North American Spine Society (NASS) annual meeting.

"Degenerative cervical myelopathy is the most common cause of spinal cord impairment in the elderly. It is not unusual to see patients with multilevel spondylosis and multilevel spinal cord compression leading to myelopathy with relative preservation of their lordosis. However, no compelling data exists on whether laminectomy and fusion or laminoplasty is the superior treatment for these patients," said Carlo Santaguida, MD, of McGill University, Montreal, Quebec, Canada. 

Study methodology
Dr. Santaguida and his fellow researchers conducted a planned pooled analysis of North American (12 sites; 278 patients) and international (16 sites; 479 patients) prospective multicenter CSM studies. Inclusion criterion was clinical diagnosis of CSM confirmed by radiologic imaging. Patients with concomitant lumbar stenosis and trauma and those who had undergone prior surgery for CSM were excluded.

Among the 757 patients, 166 patients (mean age = 61 years) had undergone laminectomy and fusion; 100 patients (mean age = 60 years) had undergone laminoplasty. The researchers used the following measures to compare outcomes between the two procedures:

  • Nurick score
  • modified Japanese Orthopedic Association (mJOA) score
  • Neck Disability Index
  • Short Form-36 physical/mental component scores

The investigators also examined patient gender, smoking status, the number of surgical levels, and baseline scores.

Similar levels of improvement
Although the two patients groups were relatively well-matched, the researchers noted a tendency toward more severe baseline mJOA scores and shorter symptom duration in the laminoplasty cohort. In addition, most of the laminoplasty cases were from the Asia Pacific region, while most of the laminectomy and fusion cases were from North America.

Overall, 222 patients (laminectomy and fusion = 140; laminoplasty = 82) were available at 12-month follow-up. After adjusting for covariates, the levels of improvement in outcomes scores were similar among all patients (Table 1).

"Laminectomy and fusion and laminoplasty are both effective options, and there did not appear to be any significant differences between the groups," Dr. Santaguida concluded.  "However, there are likely subgroups within these cohorts that would benefit from one procedure over the other. Part of our ongoing work will be to examine the imaging characteristics of these cohorts to further our understanding of this patient population."

"Laminectomy and Fusion Versus Laminoplasty for Treatment of Cervical Spondylotic Myelopathy: Results from the AOSpine North America and International Prospective Multicenter CSM Studies" was selected as one of 21 "Best Papers" during the NASS annual meeting.

The study was funded by AOSpine North America, Inc.

Dr. Santaguida's coauthors are Michael G. Fehlings, MD, PhD, FRCSC; Branko Kopjar, MD, PhD; Paul M. Arnold, MD; Helton Luiz A. Defino, MD, PhD; Shashank Kale, MD; S. Tim Yoon, MD, PhD; Guiseppe Barbagallo, MD; Ronald Bartels, MD, PhD; Qiang Zhou, MD; and Alexander R. Vaccaro, MD, PhD.

Maureen Leahy is assistant managing editor of AAOS Now. She can be reached at leahy@aaos.org

Bottom Line

  • CSM is the most common cause of myelopathy in the elderly.
  • In patients with relatively preserved cervical lordosis, laminectomy and fusion and laminoplasty are two posterior surgical decompression options for CSM.
  • Results of this pooled analysis indicate that laminectomy and fusion and laminoplasty are both effective options for CSM in elderly patients and are associated with similar levels of improvement.

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