Reviews of posterior cervical laminectomy and fusion

Ross Hauser, MD

Extending a posterior cervical fusion into the upper thoracic spine

A May 2022 study in the Journal of Neurosurgery. Spine (1) led by doctors at the Combined Neurosurgical and Orthopedic Spine Program, Department of Orthopedics Surgery, University of British Columbia. Western University, London, Ontario, the University of Toronto, and the University of Calgary, asked the question: Does extending a posterior cervical fusion into the upper thoracic spine help a patient with degenerative cervical myelopathy?

The paper abstract begins this way: “In multilevel posterior cervical instrumented fusion, an extension of fusion across the cervicothoracic junction at T1 or T2 has been associated with decreased rates of reoperation and pseudarthrosis (fusion failure).” However, they add, “the impact on patient-reported outcomes  remains unclear.” In other words, does this really help the patient?

To answer this question, the researchers set out a study whose results would help determine if an extension of fusion through the cervicothoracic junction influenced patient-reported outcomes at three, 12, and 24 months after surgery. The secondary objective was to compare the number of patients who reached the minimal clinically important differences (they benefited).

They answer then: Does extending a posterior cervical fusion into the upper thoracic spine help a patient with degenerative cervical myelopathy? The answer is No.

Cervical laminoplasty and laminectomy with fusion

A May 2022 study in The Journal of the American Academy of Orthopaedic Surgeons (2) comes to us from Rhode Island Hospital, Warren Alpert Medical School/Brown University, and Massachusetts General Hospital, Harvard Medical School. Here a comparison for better outcomes is made between cervical laminoplasty and laminectomy with fusion to treat cervical spondylotic myelopathy.

The researchers note that “conflicting data exist regarding which operation provides superior patient outcomes while minimizing the risk of complications.” To answer this question, this study evaluates the trends of cervical laminoplasty compared with laminectomy with fusion over the past decade in patients with cervical myelopathy and examines long-term revision rates and complications between the two procedures.

Research conclusion: Up to 5 years of follow-up, there were no differences in revision rates for cervical laminoplasty compared with laminectomy with fusion; however, cervical laminoplasty was associated with fewer postoperative complications than laminectomy with fusion.

1 Charest-Morin R, Bailey CS, McIntosh G, Rampersaud YR, Jacobs WB, Cadotte DW, Paquet J, Hall H, Weber MH, Johnson MG, Nataraj A. Does extending a posterior cervical fusion construct into the upper thoracic spine impact patient-reported outcomes as long as 2 years after surgery in patients with degenerative cervical myelopathy?. Journal of Neurosurgery: Spine. 2022 May 6;1(aop):1-9. [Google Scholar]
2 McDonald CL, Hershman SH, Hogan W, Alsoof D, DiSilvestro KJ, Zhang AS, Kuris EO, Daniels AH. Cervical Laminoplasty Versus Posterior Laminectomy and Fusion: Trends in Utilization and Evaluation of Complication and Revision Surgery Rates. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2022 May 13:10-5435. [Google Scholar]

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