Laminoplasty with selective fusion at unstable segment versus laminectomy with fusion for multilevel cervical myelopathy: a case‐control study

Background Segmental cervical instability is a risk factor for the progression of osteophytic bone spurs and development of myelopathy, and is treated as a relative contraindication of cervical laminoplasty. The aim of this study was to compare laminoplasty with selective fixation (LPSF) versus laminectomy with fusion (LCF) in patients with multilevel cervical myelopathy accompanied by segmental instability. Methods A case-control study was conducted by reviewing data from 63 patients who underwent LPSF (n = 30) or LCF (n = 33). Cervical alignment, range of motion (ROM), neurologic status and axial symptom severity pre-operation, 3-days after operation, and at the final follow-up (minimum 24 months) were measured and compared between groups. Results Postoperation, patients in the LPSF group lost 31.1 ± 17.3 % of cervical lordosis and 43.2 ± 10.9 % cervical ROM while patients in the LCF group lost 5.7 ± 8.2 % and 67.9 ± 15.5 %, respectively. Both LPSF and LCF groups significantly improved neurologic status and axial symptom severity at the final follow-up with similar between-group results(P > 0.05). Blood loss, operation time, hospital stay, and medical cost in the LPSF group were significantly less than in the LCF group(P < 0.05). Conclusions In 2 years of clinical observation, LPSF was effective in maintaining the stability of the cervical spine with less sacrifice of mobility and surgical trauma for multilevel myelopathy with segmental instability compared to LCF.

Optimal Time Period of Wearing Protective Collar After Anterior Cervical Discectomy and Fusion

Background: There is still no consensus on the time period of wearing collar after anterior cervical discectomy and fusion (ACDF). We aim to investigate the optimal time period of wearing protective collar.Methods: We retrospectively reviewed patients with cervical spondylosis who underwent one to two segment ACDF during January 2016 and December 2017, and included 97 patients who meet inclusion and exclusion criterion. Patients were divided into three groups according to the actual time period of wearing collar after ACDF including 1-4 week group, 5-8 week group, and 9-12 week group. We analyzed Japanese Orthopedic Association (JOA) score, Axial Symptom (AS) score and Neck Disability Index (NDI) before surgery and at post-operative 3 months to investigate the optimal time period of wearing collar.Results: JOA score: All three groups have a better post-operative JOA score compared with that before surgery (paired t test, p<0.05). There is no significant difference among the three groups with respect to post-operative JOA (ANOVA, p>0.05).AS score: The post-operative AS scores of 1-4 week group and 5-8 week group were significantly better than that before surgery (paired t test, p>0.05). While the post-operative AS score of 9-12 week group was significantly worse than preoperative AS score (paired t test, p<0.05).NDI: All three groups have a better post-operative NDI compared with that before surgery (McNemar test, p<0.05). Of note, in 5-8 week group, the percentage of no deficit increased by 45%, and the percentage of mild deficit decreased by 45% accordingly. That percentage is 26% and 31% in 1-4 week group and 9-12 week group, respectively. There was significant difference among these three groups (Fisher's exact probability test, p<0.05)Conclusions: For cervical spondylosis patients who underwent 1-2 segment ACDF, the optimal time period of wearing protective is 5-8 weeks. This time period results in comparable neurological outcome, least axial symptom risk, and highest chance of no deficit on neck function.

Laminoplasty with selective fusion at unstable segment versus laminectomy with fusion for multilevel cervical myelopathy: A retrospective comparative study

Purpose The aim of this study was to compare laminoplasty with selective fixation (LPSF) versus laminectomy with fusion (LCF) in patients with multilevel cervical myelopathy accompanied by segmental instability.Methods A retrospective cohort study was conducted by reviewing data from 63 patients who underwent LPSF (n=30) or LCF (n=33). Cervical alignment, range of motion (ROM), neurologic status and axial symptom severity pre-operation, 3-days after operation, and at the final follow-up (minimum 24 months) were measured and compared between groups.Results Postoperation, patients in the LPSF group lost 31.1±17.3% of cervical lordosis and 43.2±10.9% cervical ROM while patients in the LCF group lost 5.7±8.2% and 67.9±15.5%, respectively. Both LPSF and LCF groups significantly improved neurologic status and axial symptom severity at the final follow-up with similar between-group results(P>0.05). Blood loss, operation time, hospital stay, and medical cost in the LPSF group were significantly less than in the LCF group(P<0.05). The incidence of negative events were statistically similar between groups.Conclusion According to our results, LPSF was effective in maintaining the stability of the cervical spine with less sacrifice of mobility and surgical trauma for multilevel myelopathy with segmental instability compared to LCF.