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).
- A total of 198 patients were included in this study (101 patients with fusion not crossing the cervicothoracic junction at T1 or T2 and 97 with fusion crossing the CTJ).
- Patients with a construct extending through the cervicothoracic junction at T1 or T2 were more likely to be female.
- There were no statistically significant differences in patient-reported outcomes between patients with a posterior construct extending to the upper thoracic spine and those without such extension for as long as 24 months after surgery.
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.
- Study patients:
- 1,420 patients underwent cervical laminoplasty and 10,440 patients underwent laminectomy with fusion.
- According to the study: On matched analysis, cervical laminoplasty exhibited lower rates of wound complications, surgical site infections, spinal cord injury, dysphagia, cervical kyphosis, limb paralysis, incision and drainage/exploration, implant removal, respiratory failure, renal failure, and sepsis. Revision rates for both procedures were not different at any time point.
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.
An April 2023 study in the publication Journal of neurosurgery. Spine. (3) compared changes in spinal cord biomechanics after laminectomy with fusion, laminectomy, and laminoplasty using a computer generated model of a patient’s neck who suffered from degenerative cervical myelopathy. The researchers found that compared with laminectomy and laminoplasty, spinal cord biomechanics for laminectomy with fusion revealed significantly reduced median extension stress, lateral bending strain, axial rotation stress, and axial rotation strain. Compared with motion-preserving approaches such as laminectomy and laminoplasty, laminectomy with fusion was associated with the lowest spinal cord stress and strain in flexion-extension, lateral bending, and axial rotation of the neck.
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]
3 Vedantam A, Harinathan B, Warraich A, Budde MD, Yoganandan N. Differences in spinal cord biomechanics after laminectomy, laminoplasty, and laminectomy with fusion for degenerative cervical myelopathy. J Neurosurg Spine. 2023 Apr 7:1-12. doi: 10.3171/2023.3.SPINE2340.
This article was updated April 8, 2023