Document Detail


Treatment of cervical stenotic myelopathy: a cost and outcome comparison of laminoplasty versus laminectomy and lateral mass fusion.
MedLine Citation:
PMID:  21388285     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECT: Cervical stenotic myelopathy due to spondylosis or ossification of the posterior longitudinal ligament is often treated with laminoplasty or cervical laminectomy (with fusion). The goal of this study was to compare outcomes, radiographic results, complications, and implant costs associated with these 2 treatments.
METHODS: The authors analyzed the records of 56 patients (age range 42–81 years) who were surgically treated for cervical stenosis. Of this group, 30 underwent laminoplasty and 26 underwent laminectomy with fusion. Patients who had cervical kyphosis or spondylolisthesis were excluded. An average of 4 levels were instrumented in the laminoplasty group and 5 levels in the fusion group (p < 0.01). Forty-two percent of the fusions crossed the cervicothoracic junction, but no laminoplasty instrumentation crossed the cervicothoracic junction, and it only reached C-7 in one-third of the cases. Preoperative and postoperative Nurick grades and modified Japanese Orthopaedic Association (mJOA) scores were obtained. Outcomes were also assessed with neck pain visual analog scale (VAS) scores and the Odom outcome criteria. Postoperative length of stay, complications, and implant costs were calculated.
RESULTS: The mean duration of follow-up, average patient age, and length of hospital stay were similar for both groups. The mean Nurick scores were also similar in the 2 groups and improved an average of 1.4 points in both (p < 0.01 for preoperative-postoperative comparison in each group). The mean mJOA scores improved 2.7 points in laminoplasty patients and 2.8 points in fusion patients (p < 0.01 for each group). The mean VAS scores for neck pain did not change significantly in the laminoplasty cohort (3.2 ± 2.8 [SD] preoperatively vs 3.4 ± 2.6 postoperatively, p = 0.50). In the fusion cohort, the mean VAS scores improved from 5.8 ± 3.2 to 3.0 ± 2.3 (p < 0.01). Excellent or good Odom outcomes were observed in 76.7% of the patients in the laminoplasty cohort and 80.8% of those in the fusion cohort (p = 0.71). In the fusion group, complications were twice as common and implant costs were nearly 3 times as high as in the laminoplasty group. When cases involving fusions crossing the cervicothoracic junction were excluded, analysis showed similar complication rates in the 2 groups.
CONCLUSIONS: Patients treated with laminoplasty and patients treated with laminectomy and fusion had similar improvements in Nurick scores, mJOA scores, and Odom outcomes. Patients who underwent fusion typically had higher preoperative neck pain scores, but their neck pain improved significantly after surgery. There was no significant change in the neck pain scores of patients treated with laminoplasty. Our series suggests cervical fusion significantly reduces neck pain in patients with stenotic myelopathy, but that the cost of the implant and rate of reoperation are greater than in laminoplasty.
Authors:
Jason M Highsmith; Sanjay S Dhall; Regis W Haid; Gerald E Rodts; Praveen V Mummaneni
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Journal of neurosurgery. Spine     Volume:  14     ISSN:  1547-5646     ISO Abbreviation:  J Neurosurg Spine     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-06-15     Completed Date:  2011-07-26     Revised Date:  2012-01-11    
Medline Journal Info:
Nlm Unique ID:  101223545     Medline TA:  J Neurosurg Spine     Country:  United States    
Other Details:
Languages:  eng     Pagination:  619-25     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery, Emory University, Atlanta, Georgia, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Cervical Vertebrae / surgery*
Female
Humans
Laminectomy / economics*,  methods*
Length of Stay / statistics & numerical data
Magnetic Resonance Imaging
Male
Middle Aged
Ossification of Posterior Longitudinal Ligament / complications,  surgery*
Pain Measurement
Spinal Stenosis / etiology,  surgery*
Spondylosis / complications,  surgery*
Tomography, X-Ray Computed
Treatment Outcome
Vertebroplasty / economics*,  methods*
Comments/Corrections
Comment In:
J Neurosurg Spine. 2011 Dec;15(6):690-1; author reply 691   [PMID:  21961999 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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