Corpectomy Versus Laminoplasty for Multilevel Cervical Myelopathy:
An Independent Matched-Cohort Analysis
[Cervical Spine]
Spine, 2002;27:1168-1175
The treatment of choice for multilevel cervical myelopathy remains a matter of investigation.
Conclusions: Both multilevel corpectomy and laminoplasty reliably arrest myelopathic progression in multilevel cervical myelopathy and can lead to significant neurologic recovery and pain reduction in a majority of patients. Surprisingly, the laminoplasty cohort tended to require less pain medication at final follow-up than did the multilevel corpectomy cohort.
Cervical stenosis involving three or more levels is associated with a less predictable outcome and a higher frequency of complications.
Laminectomy, however, fell into relative disfavor because of well-known sequelae, such as segmental instability, kyphosis, perineural adhesions, and late neurologic
A retrospective review of all patients with MCM undergoing spine surgery between 1994 and 1999 was carried out. Of the 432 patients identified, 64 underwent multilevel corpectomy with fusion, and 26 underwent laminoplasty for the surgical treatment of MCM involving three or more motion segments. Thirty-eight patients fulfilled the following strict criteria for inclusion in the study.
The progression of MCM was arrested in all laminoplasty patients.
Complications in the corpectomy cohort were progression of myelopathy (1), nonunion (1), screw malposition with subjacent segment ankylosis,1 persistent dysphagia (4), and persistent dysphonia (2).
Complications in the laminoplasty cohort were limited to one patient who experienced the onset of radicular pain 6 months after surgery.
With regard to complications among these two study groups, laminoplasty proved to be significantly less troublesome than corpectomy. Most of the complications in the corpectomy cohort relate to the surgical approach. Persistent dysphagia alone or dysphagia combined with dysphonia was experienced by four patients (31%).
In conclusion, both corpectomy and laminoplasty reliably arrest myelopathic progression in MCM. Both procedures lead to significant neurologic improvement and pain reduction in a majority of patients. Corpectomy may result in a higher rate of complications and thus less satisfactory overall recovery than laminoplasty.
Reference:
1. Adams CB, Logue V. Studies in cervical spondylotic myelopathy: I. Movement of the cervical roots, dura and cord and their relation to the course of the extrathecal roots. Brain 1971; 94:557-68