[Comparison of effectiveness between laminoplasty and laminectomy decompression and fusion with internal fixation for cervical spondylotic myelopathy].

OBJECTIVE: To compare the clinical and radiographic outcomes between laminoplasty and laminectomy compression and fusion with internal fixation to treat cervical spondylotic myelopathy.

METHODS: Between September 2006 and September 2009, 143 cases of multilevel cervical myelopathy (the affected segments were more than 3) were treated by laminoplasty in 87 cases (group A) and by laminectomy decompression and fusion with lateral mass screw fixation in 56 cases (group B). There was no significant difference in gender, age, disease duration, pathological type, and affected segments between 2 groups (P > 0.05). The operation time, intraoperative blood loss, improvement of neurological function [Japanese Orthopaedic Association (JOA) 17 score], and the incidences of complications were observed; the cervical curvature index (CCI), range of motion (ROM), and symptoms of neck and shoulder pain [visual analogue scale (VAS) and neck disability index (NDI) scores] were recorded and compared.

RESULTS: There was no significant difference in operation time and intraoperative blood loss between 2 groups (P > 0.05). All patients were followed up 18-30 months (mean, 24 months). C5 nerve root palsy occurred in 4 cases (4.60%) of group A and in 5 cases (8.93%) of group B, showing no significant difference (chi2 = 0.475, P = 0.482). No complication of deep infection, pseudarthrosis, or screw loosening occurred. No closure of opened laminae was observed in group A; and no screw extrusion, breakage, or nerve injury was observed in group B. At last follow-up, neck axial symptoms appeared in 35 cases (40.23%) of group A and in 11 cases (19.64%) of group B, showing significant difference (chi2 = 6.612, P = 0.009). No significant difference was found in JOA score, CCI, ROM, or VAS scores between 2 groups at preoperation (P > 0.05); the JOA score, ROM, and VAS scores of groups A and B and CCI of group A at last follow-up were significantly improved when compared with preoperative ones (P < 0.05). No significant difference was found in the JOA score, improvement rate, and VAS score between 2 groups (P > 0.05); however, significant differences were found in ROM and CCI between 2 groups (P < 0.05). There were significant differences (P < 0.05) in pain intensity, lifting, work, reaction, driving, and total score between 2 groups at last follow-up.

CONCLUSION: Laminectomy decompression and fusion with internal fixation can effectively relieve pain, but it will greatly reduce the ROM; laminoplasty has less complications and satisfactory outcome. The two methods have similar effectiveness in the improvement of neurological function.