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

  • Authors: Byvaltsev V.A.1, Kalinin A.A.2, Aliyev M.A.2, Shepelev V.V.2, Yusupov B.R.2, Aglakov B.M.2
  • Affiliations:
    1. 1 Irkutsk State Medical University, Irkutsk, Russian Federation 2 Irkutsk Scientific Center of Surgery and Traumatology, Irkutsk, Russian Federation 3 Irkutsk State Academy of Postgraduate Education, Irkutsk, Russian Federation
    2. - Irkutsk State Medical University, Irkutsk, Russian Federation
  • URL: https://vestnikramn.spr-journal.ru/jour/article/view/1160
  • DOI: https://doi.org/10.15690/vramn1160
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Abstract


Backgraund: 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: to conduct a meta-analysis based on the results of prospective cohort clinical studies that compare the results of laminoplasty and laminectomy techniques with instrumental fixation in treating patients with multilevel degenerative diseases of the cervical spine. Materials and methods: A search for prospective cohort clinical studies published till May 2019 which compared the results of using LP and LF techniques for treatment patients with multilevel degenerative diseases of the cervical spine was conducted in the Pubmed, CNKI, ELibrary and Cochrane Library databases. For dichotomous variables, the relative risk and 95% confidence intervals were calculated; in turn, standardized difference of mean values and their 95% confidence intervals were used for continuous variables, using the random effects model. Results: The meta-analysis included 6 prospective cohort studies, two of which were randomized clinical trials. In total, the results of surgical treatment of 493 patients with multilevel degenerative diseases of the cervical spine were evaluated. Duration of surgery was significantly lower (p<0,00001) in LP group, the LF group verified a lower level of pain in the cervical spine (p=0,05). The functional status measured by NDI and JOA, and the number of perioperative complications were comparable in both groups (р=0,94, р=0,96, р=0,14 respectively). Conclusions: This meta-analysis demonstrated that the functional outcomes of LP and LF in the treatment of multilevel degenerative diseases of the cervical spine are not significantly different. However LP technique can be performed within a shorter period of time compared to LF and in the long-term period, the level of pain syndrome according to VAS was registered less after LF as compared with LP.


Vadim A. Byvaltsev

1 Irkutsk State Medical University, Irkutsk, Russian Federation
2 Irkutsk Scientific Center of Surgery and Traumatology, Irkutsk, Russian Federation
3 Irkutsk State Academy of Postgraduate Education, Irkutsk, Russian Federation

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

Russian Federation MD, Professor, Head of the Department of Neurosurgery and Innovative Medicine, Irkutsk State Medical University; 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, Irkutsk Scientific Center for Surgery and Traumatology; Professor of the Department of Traumatology, Orthopedics and Neurosurgery of the Irkutsk State Medical Academy of Postgraduate Education.

Andrey A. Kalinin

- Irkutsk State Medical University, Irkutsk, Russian Federation

Email: andrei_doc_v@mail.ru
ORCID iD: 0000-0001-9039-9147

Russian Federation PhD, Associate Professor, Department of Neurosurgery and Innovative Medicine, Irkutsk State Medical University

Marat A. Aliyev

- Irkutsk State Medical University, Irkutsk, Russian Federation

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

Kazakhstan Ph.D., Doctoral Candidate of the Department of Neurosurgery and Innovative Medicine, Irkutsk State Medical University

Valery V. Shepelev

- Irkutsk State Medical University, Irkutsk, Russian Federation

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

Russian Federation Ph.D., Doctoral Candidate of the Department of Neurosurgery and Innovative Medicine, Irkutsk State Medical University

Bobur R. Yusupov

- Irkutsk State Medical University, Irkutsk, Russian Federation

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

Kazakhstan Postgraduate Student, Department of Neurosurgery and Innovative Medicine, Irkutsk State Medical University

Bakhyt M. Aglakov

- Irkutsk State Medical University, Irkutsk, Russian Federation

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

Kazakhstan Postgraduate Student, Department of Neurosurgery and Innovative Medicine, Irkutsk State Medical University

  • 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).]
  • 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.
  • 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. – URL: http://www.science-education.ru/article/view?id=28685 (дата обращения: 28.03.2019). [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 obrazovaniya. 2019;2: URL: http://www.science-education.ru/article/view?id=28685 (In Russ).] doi: 10.17513/spno.28685.
  • 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.
  • 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. Prakticheskaya medicina. 2018;16(9):82-86. (In Russ).]
  • Chen TP, Qian LG, Jiao JB, Li QG, Sun B, Chen K, Wang YF, Liang ZX, Chen YM, Meng J. 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.
  • 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.
  • 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. doi: 10.1007/s00402-018-03102-6.
  • 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. Genij ortopedii. 2018;24(2):216-220. (In Russ).]
  • 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.
  • 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.
  • 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.
  • 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):2302-10. doi: 10.1007/s00586-016-4524-2.
  • 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.
  • 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.
  • Brasil AVB, Fruett da Costa PR, Vial ADM, et al. Cervicothoracic Lordosis Can Influence Outcome After Posterior Cervical Spine Surgery. Open Orthop J. 2018;12:91-98. doi: 10.2174/1874325001812010091.
  • 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.
  • 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.
  • Wells GA, Shea B, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses [Internet]. [Accessed July 31, 2018]. Available from: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
  • 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.
  • 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.
  • Bai ZF, Zhang XH. Effects of laminectomy and fusion on 32 cases of cervical ossification of the posterior longitudinal ligament. J ShanxiMed. 2015;44:1232–1235.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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.
  • 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):589-95. doi: 10.3171/2014.10.SPINE1498.
  • 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.
  • 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.
  • 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.
  • 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):S183-94. doi: 10.1097/BRS.0b013e3182a7eb7c.
  • Kiely PD, Quinn JC, Du JY, Lebl DR. Posterior surgical treatment of cervical spondylotic myelopathy: review article. HSS J. 2015;11(1):36-42. doi: 10.1007/s11420-014-9425-5.
  • 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.
  • 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.

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