A meta-analysis of prospective studies comparing the results of laminoplasty and laminectomy with instrumental fixation in the surgical treatment of patients with multilevel degenerative cervical spine diseases

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Abstract


Background: Dorsal decompressive-stabilizing techniques — laminotomy with laminoplasty (LP) and laminectomy with instrumental fixation (LF) are effective methods for surgical treatment of patients with multi-level degenerative diseases of the cervical spine. At the same time, there is currently no priority in determining the optimal method for posterior decompression and stabilization.

Aim: conduct a comparative analysis of intraoperative parameters, clinical outcomes, radiological results and complications of LP and LF in the treatment of patients with multilevel degenerative diseases of the cervical spine.

Methods: A meta-analysis of prospective cohort clinical trials was carried out, the primary sources were searched using the databases PubMed, CNKI, eLibrary and the Cochrane Library, published until March 2019, which compared the results of applying the LP and LF methods in the treatment of patients with multilevel degenerative diseases of the cervical spine. For dichotomous variables, the relative risk and the 95% confidence interval were calculated; in turn, for the continuous variables, the standardized difference of the mean values and their 95% confidence intervals were used, using random effect models and a fixed effect.

Resuts: The meta-analysis included 6 prospective clinical trials, one of which was a randomized controlled trial. In total, the results of surgical treatment of 493 patients with multilevel degenerative diseases of the cervical spine were evaluated. In the group of drugs, statistically significantly smaller parameters of the duration of surgical intervention were verified (p < 0.00001). At the same time, comparable parameters of cervical lordosis after surgery, the level of pain in the cervical spine, functional status according to NDI and JOA after surgery, the frequency of perioperative complications (p = 0.17, p = 0.05, p = 0.94, p = 0.96, p = 0.24, respectively).

Conclusions: A meta-analysis showed that the functional outcomes of LP and LF, as well as instrumental results in the treatment of multilevel degenerative diseases of the cervical spine, are not clinically significant. In this case, the LP technique can be performed in a shorter period of time compared with LF.


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About the authors

Vadim A. Byvaltsev

Irkutsk State Medical University; Irkutsk Scientific Center of Surgery and Traumatology; Irkutsk State Academy of Postgraduate Education

Author for correspondence.
Email: byval75vadim@yandex.ru
ORCID iD: 0000-0003-4349-7101
SPIN-code: 5996-6477

Russian Federation, 1, Krasnogo Vosstaniya st., Irkutsk, 664003; 1, Bortsov Revolitsii street, Irkutsk, 664003; 100-4, Yubileiny distr., Irkutsk region, Irkutsk, 664049

MD, Professor, Head of the Department of Neurosurgery and Innovative Medicine; Chief Neurosurgeon of JSC “Russian Railways”, Head of Neurosurgery Center, NUZ “Road Clinical Hospital at st. Irkutsk-Passenger "JSC" Russian Railways "; Deputy Director for International and Innovation Activities; Professor of the Department of Traumatology, Orthopedics and Neurosurgery

Andrey A. Kalinin

Irkutsk State Medical University; Irkutsk Scientific Center of Surgery and Traumatology

Email: andrei_doc_v@mail.ru
ORCID iD: 0000-0001-9039-9147
SPIN-code: 9707-8291

Russian Federation, 1, Krasnogo Vosstaniya st., Irkutsk, 664003; 1, Bortsov Revolitsii street, Irkutsk, 664003

MD, PhD, Assistant Professor

Marat A. Aliev

Irkutsk State Medical University

Email: a.marat.a0903@mail.ru
ORCID iD: 0000-0002-7676-1127

Russian Federation, 1, Krasnogo Vosstaniya st., Irkutsk, 664003

MD, PhD, Doctoral Candidate

Valeriy V. Shepelev

Irkutsk State Medical University

Email: shepelev.dok@mail.ru
ORCID iD: 0000-0001-5135-8115

Russian Federation, 1, Krasnogo Vosstaniya st., Irkutsk, 664003

MD, PhD, Doctoral Candidate

Bobur R. Yusupov

Irkutsk State Medical University

Email: yusupov_babur@mail.ru
ORCID iD: 0000-0001-9175-6871

Kazakhstan, 1, Krasnogo Vosstaniya st., Irkutsk, 664003

Postgraduate Student

Bakhyt M. Aglakov

Irkutsk State Medical University

Email: aglakov_jan@mail.ru
ORCID iD: 0000-0001-5458-0184

Kazakhstan, 1, Krasnogo Vosstaniya st., Irkutsk, 664003

Postgraduate Student

References

  1. Бывальцев В.А., Сороковиков В.А., Калинин А.А., Белых Е.Г. Анализ результатов переднего шейного спондилодеза с использованием гибридного кейджа РСВ Evolution за двухлетний период // Вопросы нейрохирургии им. Н.Н. Бурденко. ― 2013. ― №1. ― С. 37−45. [Byvaltsev VA, Sorokovikov VA, Kalinin AA, Belykh EG. Analysis of the results of anterior cervical spinal fusion using a PCB Evolution hybrid cage for a two-year period. Zh Vopr Neirokhir im NN Burdenko. 2013;(1):37−45. (In Russ).]
  2. Ma L, Liu FY, Huo LS, et al. Comparison of laminoplasty versus laminectomy and fusion in the treatment of multilevel cervical ossification of the posterior longitudinal ligament: A systematic review and meta-analysis. Medicine (Baltimore). 2018;97(29):e11542. doi: 10.1097/MD.0000000000011542.
  3. Бывальцев В.А., Калинин А.А., Алиев М.А., и др. Сравнительный анализ результатов ламинопластики и ламинэктомии с фиксацией за боковые массы при лечении пациентов с многоуровневыми дегенеративными заболеваниями шейного отдела позвоночника // Современные проблемы науки и образования. ― 2019. ― №2. ― С. 135. [Byvaltsev VA, Kalinin AA, Aliyev MA, et al. Comparative analysis of the results of laminoplasty and laminectomy with fixation of the lateral masses in the treatment of patients with multilevel degenerative diseases of the cervical spine. Sovremennye problemy nauki i obrazovaniia. 2019;2:135. (In Russ).] doi: 10.17513/spno.28685.
  4. Phan K, Scherman DB, Xu J, et al. Laminectomy and fusion vs laminoplasty for multi-level cervical myelopathy: a systematic review and meta-analysis. Eur Spine J. 2017;26(1):94−103. doi: 10.1007/s00586-016-4671-5.
  5. Бывальцев В.А., Калинин А.А., Алиев М.А., и др. Клиническая эффективность ламинопластики при лечении пациентов с многоуровневыми дегенеративными заболеваниями шейного отдела позвоночника // Практическая медицина. ― 2018. ― Т.16. ― №9. ― С. 82−86. [Byvaltsev VA, Kalinin AA, Aliyev MA, et al. Clinical efficacy of laminoplasty in the treatment of patients with multilevel degenerative diseases of the cervical spine. Prakticheskaia meditsina. 2018;16(9):82−86. (In Russ).]
  6. 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 (Baltimore). 2019;98(1):e13382. doi: 10.1097/MD.0000000000013382.
  7. Hirai T, Yoshii T, Arai Y, et al. A Comparative study of anterior decompression with fusion and posterior decompression with laminoplasty for the treatment of cervical spondylotic myelopathy patients with large anterior compression of the spinal cord. Clin Spine Surg. 2017;30(8):E1137−E1142. doi: 10.1097/BSD.0000000000000500.
  8. Zhang L, Chen J, Cao C, et al. Anterior versus posterior approach for the therapy of multilevel cervical spondylotic myelopathy: a meta-analysis and systematic review. Arch Orthop Trauma Surg. 2019;139(6):735−742. doi: 10.1007/s00402-018-03102-6.
  9. Бурцев А.В., Губин А.В., Рябых С.О., и др. Синдромальный подход при оценке хирургической патологии шейного отдела позвоночника // Гений ортопедии. ― 2018. ― Т.24. ― №2. ― С. 216−220. [Burtsev AV, Gubin AV, Ryabykh SO, et al. Syndromic approach in the assessment of surgical pathology of the cervical spine. Genii ortopedii. 2018;24(2):216−220. (In Russ).]
  10. Singhatanadgige W, Limthongkul W, Valone F, et al. Outcomes following laminoplasty or laminectomy and fusion in patients with myelopathy caused by ossification of the posterior longitudinal ligament: a systematic review. Global Spine J. 2016;6(7):702−709. doi: 10.1055/s-0036-1578805.
  11. Yang L, Gu Y, Shi J, et al. Modified plate-only open-door laminoplasty versus laminectomy and fusion for the treatment of cervical stenotic myelopathy. Orthopedics. 2013;36(1):e79−87. doi: 10.3928/01477447-20121217-23.
  12. Adogwa O, Huang K, Hazzard M, et al. Outcomes after cervical laminectomy with instrumented fusion versus expansile laminoplasty: a propensity matched study of 3185 patients. J Clin Neurosci. 2015;22(3):549−553. doi: 10.1016/j.jocn.2014.10.001.
  13. Wang M, Luo XJ, Deng QX, et al. Prevalence of axial symptoms after posterior cervical decompression: a meta-analysis. Eur Spine J. 2016;25(7):2302−2310. doi: 10.1007/s00586-016-4524-2.
  14. Bakhsheshian J, Mehta VA, Liu JC. Current diagnosis and management of cervical spondylotic myelopathy. Global Spine J. 2017;7(6):572−586. doi: 10.1177/2192568217699208.
  15. Singrakhia MD, Malewar NR, Singrakhia SM, Deshmukh SS. Cervical laminectomy with lateral mass screw fixation in cervical spondylotic myelopathy: neurological and sagittal alignment outcome: do we need lateral mass screws at each segment? Indian J Orthop. 2017;51(6):658−665. doi: 10.4103/ortho.IJOrtho_266_16.
  16. Brasil AV, Fruett da Costa PR, Vial AD, et al. Cervicothoracic lordosis can influence outcome after posterior cervical spine surgery. Open Orthop J. 2018;12:91−98. doi: 10.2174/1874325001812010091.
  17. Lee JS, Son DW, Lee SH, et al. The predictable factors of the postoperative kyphotic change of sagittal alignment of the cervical spine after the laminoplasty. J Korean Neurosurg Soc. 2017;60(5):577−583. doi: 10.3340/jkns.2017.0505.007.
  18. Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol. 2009;62(10):1−34. doi: 10.1016/j.jclinepi.2009.06.006.
  19. Реброва О.Ю., Федяева В.К. Мета-анализы и оценка их методологического качества. Русскоязычная версия вопросника AMSTAR // Медицинские технологии. Оценка и выбор. ― 2016. ― №1. ― С. 10−16. [Rebrova OYu, Fedyaeva VK. Meta-analyzes and assessment of their methodological quality. Russian version of the AMSTAR questionnaire. Meditsinskie tekhnologii. Otsenka i vybor. 2016;(1):10−16. (In Russ).]
  20. Wewers ME, Lowe NK. A critical review of visual analogue scales in the measurement of clinical phenomena. Res Nurs Health. 1990;13(4):227−236. doi: 10.1002/nur.4770130405.
  21. Vernon H, Mior S. The Neck Disability Index: a study of reliability and validity. J Manip Physiol Ther. 1991;14:409–415.
  22. Bartels RH, Verbeek AL, Benzel EC, et al. Validation of a translated version of the modified Japanese orthopaedic association score to assess outcomes in cervical spondylotic myelopathy: an approach to globalize outcomes assessment tools. Neurosurgery. 2010;66(5):1013−1016. doi: 10.1227/01.NEU.0000368391.79314.6F.
  23. Реброва О.Ю., Федяева В.К., Хачатрян Г.Р. Адаптация и валидизация вопросника для оценки риска систематических ошибок в рандомизированных контролируемых испытаниях // Медицинские технологии. Оценка и выбор. ― 2015. ― №1. ― С. 9−17. [Rebrova OYu, Fedyaeva VK, Khachatryan GR. Adaptation and validation of a questionnaire for assessing the risk of systematic errors in randomized controlled trials. Meditsinskie tekhnologii. Otsenka i vybor. 2015;(1):9−17. (In Russ).]
  24. Реброва О.Ю., Федяева В.К. Вопросник для оценки риска систематических ошибок в нерандомизированных сравнительных исследованиях: русскоязычная версия шкалы Ньюкасл-Оттава // Медицинские технологии. Оценка и выбор. ― 2016. ― №3. ― С. 14−19. [Rebrova OYu, Fedyaeva VK. Questionnaire for assessing the risk of systematic errors in nonrandomized comparative studies: the Russian version of the Newcastle-Ottawa scale. Meditsinskie tekhnologii. Otsenka i vybor. 2016;(3):14−19. (In Russ).]
  25. Bai ZF, Zhang XH. Effects of laminectomy and fusion on 32 cases of cervical ossification of the posterior longitudinal ligament. J Shanxi Med. 2015;44:1232–1235.
  26. Chen G, Dai T, Shi KQ. A comparison of unilateral open-door cervical expansive laminoplasty and laminectomy for treatment of ossification of the posterior longitudinal ligament. Orthop J China. 2016;24:589–602.
  27. Fehlings MG, Santaguida C, Tetreault L, et al. Laminectomy and fusion versus laminoplasty for the treatment of degenerative cervical myelopathy: results from the AOSpine North America and International prospective multicenter studies. Spine J. 2017;17(1):102−108. doi: 10.1016/j.spinee.2016.08.019.
  28. Lee CH, Jahng TA, Hyun SJ, et al. expansive laminoplasty versus laminectomy alone versus laminectomy and fusion for cervical ossification of the posterior longitudinal ligament: is there a difference in the clinical outcome and sagittal alignment? Clin Spine Surg. 2016;29(1):E9−15. doi: 10.1097/BSD.0000000000000058.
  29. Manzano GR, Casella G, Wang MY, et al. A prospective, randomized trial comparing expansile cervical laminoplasty and cervical laminectomy and fusion for multilevel cervical myelopathy. Neurosurgery. 2012;70(2):264-−277. doi: 10.1227/NEU.0b013e3182305669.
  30. Yuan W, Zhu Y, Liu X, et al. Postoperative three-dimensional cervical range of motion and neurological outcomes in patients with cervical ossification of the posterior longitudinal ligament: cervical laminoplasty versus laminectomy with fusion. Clin Neurol Neurosurg. 2015;134:17−23. doi: 10.1016/j.clineuro.2015.04.004.
  31. Wang T, Wang H, Liu S, Ding WY. Incidence of C5 nerve root palsy after cervical surgery: a meta-analysis for last decade. Medicine (Baltimore). 2017;96(45):e8560. doi: 10.1097/MD.0000000000008560.
  32. Wang T, Tian XM, Liu SK, et al. Prevalence of complications after surgery in treatment for cervical compressive myelopathy: a meta-analysis for last decade. Medicine (Baltimore). 2017;96(12):e6421. doi: 10.1097/MD.0000000000006421.
  33. Lee CH, Lee J, Kang JD, et al. Laminoplasty versus laminectomy and fusion for multilevel cervical myelopathy: a meta-analysis of clinical and radiological outcomes. J Neurosurg Spine. 2015;22(6):589−595. doi: 10.3171/2014.10.SPINE1498.
  34. Liu FY, Yang SD, Huo LS, et al. Laminoplasty versus laminectomy and fusion for multilevel cervical compressive myelopathy: a meta-analysis. Medicine (Baltimore). 2016;95(23):e3588. doi: 10.1097/MD.0000000000003588.
  35. Wang M, Luo XJ, Deng QX, et al. Prevalence of axial symptoms after posterior cervical decompression: a meta-analysis. Eur Spine J. 2016;25(7):2302−2310. doi: 10.1007/s00586-016-4524-2.
  36. Yuan X, Wei C, Xu W, et al. Comparison of laminectomy and fusion vs laminoplasty in the treatment of multilevel cervical spondylotic myelopathy: a meta-analysis. Medicine (Baltimore). 2019;98(13):e14971. doi: 10.1097/MD.0000000000014971.
  37. Yoon ST, Hashimoto RE, Raich A, et al. Outcomes after laminoplasty compared with laminectomy and fusion in patients with cervical myelopathy: a systematic review. Spine. 2013;38(22 Suppl 1):S183−194. doi: 10.1097/BRS.0b013e3182a7eb7c.
  38. Kiely PD, Quinn JC, Du JY, Leb DR. Posterior surgical treatment of cervical spondylotic myelopathy: review article. HSS J. 2015;11(1):36−42. doi: 10.1007/s11420-014-9425-5.
  39. Lao L, Zhong G, Li X, et al. Laminoplasty versus laminectomy for multi-level cervical spondylotic myelopathy: a systematic review of the literature. J Orthop Surg Res. 2013;8:45. doi: 10.1186/1749-799X-8-45.
  40. Bridges KJ, Simpson LN, Bullis CL, et al. Combined laminoplasty and posterior fusion for cervical spondylotic myelopathy treatment: a literature review. Asian Spine J. 2018;12(3):446−458. doi: 10.4184/asj.2018.12.3.446.

Supplementary files

Supplementary Files Action
1.
Fig. 1. The strategy of searching and selecting literature data for inclusion in meta-analysis

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2.
Fig. 2. Funnel-shaped diagrams for the duration of surgery (a); the severity of pain in the cervical spine according to YOUR (b); the level of quality of life of patients associated with the index of movement restriction in the cervical spine according to NDI (c); the level of quality of life of patients associated with functional status according to JOA (g); the magnitude of cervical lordosis before surgery (e); magnitude of cervical lordosis after surgery (e); frequency of perioperative complications (g)

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3.
Fig. 3. A tree diagram of the duration of the surgical intervention (min)

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4.
Fig. 4. A tree diagram of the severity of pain in the cervical spine according to YOUR after 12 months [25] and 24 months [28]

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5.
Fig. 5. Tree-like diagram of the quality of life of patients associated with the index of movement restriction in the cervical spine, according to NDI after 24 months [27, 28]

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6.
Fig. 6. A tree diagram of the quality of life of patients associated with functional status according to JOA after 12 months [25, 29]

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7.
Fig. 7. A tree diagram of the magnitude of cervical lordosis according to preoperative radiographs

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8.
Fig. 8. A tree diagram of the magnitude of cervical lordosis according to postoperative radiographs after 12 months [25, 29] and 24 months [28]

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9.
Fig. 9. A tree diagram of the frequency of perioperative complications within 12 months [25, 29, 30] and 24 months [26−28] of the postoperative observation period

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