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Predictive factors affecting outcome after cervical laminoplasty.

S Tim Yoon¹, Annie Raich, Robin E Hashimoto

¹*Emory Spine Center, Atlanta, GA †Spectrum Research, Inc., Tacoma, WA ‡Washington University Orthopedics, St. Louis, MO §Department of Neurological Surgery, University of Virginia, Charlottesville, VA; and ¶University Health Network, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; and ‖Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.

|August 22, 2013

Summary

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Early cervical laminoplasty for cervical spondylotic myelopathy (CSM) is recommended, as disease severity and symptom duration may worsen outcomes. Age is not a predictor for CSM patients undergoing this spinal decompression surgery.

Area of Science:

Neurosurgery
Orthopedic Surgery
Spinal Surgery

Background:

Cervical laminoplasty decompresses the spinal cord by enlarging the spinal canal.
Prior research suggests various preoperative factors may influence outcomes.
Cervical spondylotic myelopathy (CSM) and ossification of posterior longitudinal ligament (OPLL) are conditions treated with laminoplasty.

Purpose of the Study:

To identify preoperative factors impacting patient outcomes after cervical laminoplasty.
To evaluate associations between preoperative factors and outcomes in CSM and OPLL patients.

Main Methods:

Systematic review of cohort studies evaluating preoperative factors and outcomes.
Inclusion criteria: multivariate analysis, ≥20 patients, age adjustment.

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Outcome measures: JOA, modified JOA, and JOACMEQ-L scores.

Main Results:

Low to insufficient evidence for most predictive factors across 12 studies.
Increased age did not correlate with poorer outcomes in CSM patients.
Disease severity and symptom duration may negatively impact outcomes in CSM patients.
Hill-shaped lesions may be associated with poorer outcomes in OPLL patients.

Conclusions:

Evidence for predictive factors is generally low or insufficient.
Recommend earlier laminoplasty for CSM to avoid symptom progression.
Age alone should not disqualify CSM patients from laminoplasty.
Surgeons should consider lesion type in OPLL patients for surgical planning.