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Laminoplasty versus laminectomy with fusion for treatment of multilevel cervical compressive myelopathy: an updated meta-analysis
  1. Jing Wang1,
  2. Jin Wo2,
  3. Jun Wen1,
  4. Liu Zhang1,
  5. Weiwei Xu1,
  6. Xiangyu Wang1
  1. 1Department of Neurosurgery, Jinan University First Affiliated Hospital, Guangzhou, Guangdong, China
  2. 2Department of Orthopedics, Jinan University First Affiliated Hospital, Guangzhou, Guangdong, China
  1. Correspondence to Dr Xiangyu Wang, Department of Neurosurgery, Jinan University First Affiliated Hospital, Guangzhou, Guangdong, China; wang_xy123{at}126.com

Abstract

Background Multilevel cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament (OPLL) are debilitating degenerative diseases. If conservative treatment is ineffective, surgical options for multilevel CSM and OPLL include laminoplasty (LP) and laminectomy with fusion (LF). In this updated meta-analysis, we aimed to compare the clinical outcomes and complications of both approaches.

Methods We searched PubMed, the Cochrane Library and Embase datasets from their inception to 31 March 2020, to identify all eligible studies comparing LP versus LF for multilevel CSM and OPLL. Data were extracted according to predefined endpoints. We summarised data by the random-effects or fixed-effect models, as necessary.

Results Of 533 eligible studies, 16 were identified, which included 638 patients who underwent LP and 671 patients who underwent LF. No significant differences were observed between preoperative and postoperative scores of the Japanese Orthopaedic Association (p=1.0 and 0.20, respectively); Visual Analogue Scale (p=0.24 and 0.89, respectively); sagittal vertical axis ((p=0.16 and 0.87, respectively); Nurick Scale (p=0.59 and 0.17, respectively); and range of motion (p=0.67 and 0.63, respectively). However, total complications were higher for LF compared with LP (p=0.006). A significantly higher incidence of C5 palsy was observed in the LF group (p=0.004). The postoperative Neck Disability Index (NDI) was also higher in the LF group (p<0.001).

Conclusions Although LP and LF shared similar clinical improvement, LP had fewer complications, a lower incidence of C5 palsy, and better NDI scores and recovery outcomes than LF. Randomised studies are warranted to validate these findings.

  • neurosurgery
  • orthopaedic & trauma surgery

Data availability statement

Data are available in a public, open access repository. Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplemental information. All datasets generated for this study are included in the article/supplemental material.

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Data availability statement

Data are available in a public, open access repository. Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplemental information. All datasets generated for this study are included in the article/supplemental material.

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Footnotes

  • JW and JW contributed equally.

  • Contributors XW, who supervised this work, led the research by planning it, analysing the findings and critically revising the manuscript for crucial intellectual material. JWang assisted with data processing, results interpretation and manuscript drafting. JWo assisted with research data compilation and manuscript revision. JWen, LZ and WX assisted with results interpretation. All authors have read and agreed to the published version of the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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