Comparison of Clinical and Radiographic Outcomes of Laminoplasty, Anterior Decompression With Fusion, and Posterior Decompression With Fusion for Degenerative Cervical Myelopathy: A Prospective Multicenter Study.
Journal
Spine
ISSN: 1528-1159
Titre abrégé: Spine (Phila Pa 1976)
Pays: United States
ID NLM: 7610646
Informations de publication
Date de publication:
15 Oct 2020
15 Oct 2020
Historique:
pubmed:
25
6
2020
medline:
20
1
2021
entrez:
25
6
2020
Statut:
ppublish
Résumé
Prospective multicenter study. The aim of this study was to compare the clinical and radiographic results of laminoplasty (LAMP), anterior decompression with fusion (ADF), and posterior decompression with fusion (PDF) for degenerative cervical myelopathy (DCM). Although ADF, LAMP, and PDF have been performed for DCM, little is known about the difference in impact of these surgical treatments on clinical and radiographic outcomes. We prospectively enrolled patients who were scheduled for surgery for DCM and compared the clinical and radiographic results of ADF, LAMP, and PDF. In total, 171 patients completed the 1-year follow-up. Regarding clinical outcomes, the Japanese Orthopedic Association score for the assessment of cervical myelopathy (C-JOA score), European Quality of Life-5 Dimensions (EQ-5D), and Neck Disability Index (NDI) scores improved in all groups postoperatively. However, no significant differences were found in C-JOA, EQ-5D, and NDI scores and recovery rate among the groups. Regarding radiographic parameters, although the operation had no effect on cervical lordosis (CL) and the C2-7 sagittal vertical axis (SVA) in the ADF group, they worsened in the LAMP and PDF group. Although there were no significant differences in any preoperative radiographic parameters within the ADF and LAMP group, CL was significantly lower and the C2-7 SVA was significantly higher in the nonrecovery group within the PDF group. Logistic regression analysis showed that preoperative lower CL was an independent risk factor for poor recovery in the PDF group. Although groups showed no significant differences in clinical outcomes, cervical alignment worsened after surgery in the LAMP and PDF groups. Within the PDF group, lower CL was an independent risk factor for poor recovery. Therefore, the indications for PDF in DCM patients with preoperative kyphotic alignment should be carefully considered. 3.
Sections du résumé
STUDY DESIGN
METHODS
Prospective multicenter study.
OBJECTIVE
OBJECTIVE
The aim of this study was to compare the clinical and radiographic results of laminoplasty (LAMP), anterior decompression with fusion (ADF), and posterior decompression with fusion (PDF) for degenerative cervical myelopathy (DCM).
SUMMARY OF BACKGROUND DATA
BACKGROUND
Although ADF, LAMP, and PDF have been performed for DCM, little is known about the difference in impact of these surgical treatments on clinical and radiographic outcomes.
METHODS
METHODS
We prospectively enrolled patients who were scheduled for surgery for DCM and compared the clinical and radiographic results of ADF, LAMP, and PDF.
RESULTS
RESULTS
In total, 171 patients completed the 1-year follow-up. Regarding clinical outcomes, the Japanese Orthopedic Association score for the assessment of cervical myelopathy (C-JOA score), European Quality of Life-5 Dimensions (EQ-5D), and Neck Disability Index (NDI) scores improved in all groups postoperatively. However, no significant differences were found in C-JOA, EQ-5D, and NDI scores and recovery rate among the groups. Regarding radiographic parameters, although the operation had no effect on cervical lordosis (CL) and the C2-7 sagittal vertical axis (SVA) in the ADF group, they worsened in the LAMP and PDF group. Although there were no significant differences in any preoperative radiographic parameters within the ADF and LAMP group, CL was significantly lower and the C2-7 SVA was significantly higher in the nonrecovery group within the PDF group. Logistic regression analysis showed that preoperative lower CL was an independent risk factor for poor recovery in the PDF group.
CONCLUSION
CONCLUSIONS
Although groups showed no significant differences in clinical outcomes, cervical alignment worsened after surgery in the LAMP and PDF groups. Within the PDF group, lower CL was an independent risk factor for poor recovery. Therefore, the indications for PDF in DCM patients with preoperative kyphotic alignment should be carefully considered.
LEVEL OF EVIDENCE
METHODS
3.
Identifiants
pubmed: 32576779
doi: 10.1097/BRS.0000000000003592
pii: 00007632-202010150-00017
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
E1342-E1348Références
Davies BM, Mowforth OD, Smith EK, et al. Degenerative cervical myelopathy. BMJ 2018; 360:k186.
The Lancet Neurology. A focus on patient outcomes in cervical myelopathy. Lancet Neurol 2019; 18:615.
Bakhsheshian J, Mehta VA, Liu JC. Current diagnosis and management of cervical spondylotic myelopathy. Global Spine J 2017; 7:572–586.
Hirai T, Okawa A, Arai Y, et al. Middle-term results of a prospective comparative study of anterior decompression with fusion and posterior decompression with laminoplasty for the treatment of cervical spondylotic myelopathy. Spine (Phila Pa 1976) 2011; 36:1940–1947.
Sakai K, Okawa A, Takahashi M, et al. Five-year follow-up evaluation of surgical treatment for cervical myelopathy caused by ossification of the posterior longitudinal ligament: a prospective comparative study of anterior decompression and fusion with floating method versus laminoplasty. Spine (Phila Pa 1976) 2012; 37:367–376.
Suda K, Abumi K, Ito M, et al. Local kyphosis reduces surgical outcomes of expansive open-door laminoplasty for cervical spondylotic myelopathy. Spine (Phila Pa 1976) 2003; 28:1258–1262.
Kimura I, Shingu H, Nasu Y. Long-term follow-up of cervical spondylotic myelopathy treated by canal-expansive laminoplasty. J Bone Joint Surg Br 1995; 77:956–961.
Hirai T, Kawabata S, Enomoto M, et al. Presence of anterior compression of the spinal cord after laminoplasty inhibits upper extremity motor recovery in patients with cervical spondylotic myelopathy. Spine (Phila Pa 1976) 2012; 37:377–384.
Koda M, Mochizuki M, Konishi H, et al. Comparison of clinical outcomes between laminoplasty, posterior decompression with instrumented fusion, and anterior decompression with fusion for K-line (-) cervical ossification of the posterior longitudinal ligament. Eur Spine J 2016; 25:2294–2301.
Nunez-Pereira S, Hitzl W, Bullmann V, et al. Sagittal balance of the cervical spine: an analysis of occipitocervical and spinopelvic interdependence, with C-7 slope as a marker of cervical and spinopelvic alignment, Journal of neurosurgery. Spine (Phila Pa 1976) 2015; 23:16–23.
ISSG. The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery. Neurosurgery 2012; 71:662–669.
MacDermid JC, Walton DM, Avery S, et al. Measurement properties of the neck disability index: a systematic review. J Orthop Sports Phys Ther 2009; 39:400–417.
EuroQol Group. EuroQol—a new facility for the measurement of health-related quality of life. Health Policy 1990; 16:199–208.
Kato S, Oshima Y, Oka H, et al. Comparison of the Japanese Orthopaedic Association (JOA) score and modified JOA (mJOA) score for the assessment of cervical myelopathy: a multicenter observational study. PLoS One 2015; 10:e0123022-e.
Hirabayashi K, Miyakawa J, Satomi K, et al. Operative results and postoperative progression of ossification among patients with ossification of cervical posterior longitudinal ligament. Spine (Phila Pa 1976) 1981; 6:354–364.
Chen TP, Qian LG, Jiao JB, et al. Anterior decompression and fusion versus laminoplasty for cervical myelopathy due to ossification of posterior longitudinal ligament: a meta-analysis. Medicine 2019; 98:e13382.
Troyanovich SJ, Stroink AR, Kattner KA, et al. Does anterior plating maintain cervical lordosis versus conventional fusion techniques? A retrospective analysis of patients receiving single-level fusions. J Spinal Disord Tech 2002; 15:69–74.
Oe S, Yamato Y, Togawa D, et al. Preoperative T1 slope more than 40° as a risk factor of correction loss in patients with adult spinal deformity. Spine (Phila Pa 1976) 2016; 41:E1168–E1176.
Yoshii T, Sakai K, Hirai T, et al. Anterior decompression with fusion versus posterior decompression with fusion for massive cervical ossification of the posterior longitudinal ligament with a >/=50% canal occupying ratio: a multicenter retrospective study. Spine J 2016; 16:1351–1357.