Selective laminectomy for cervical spondylotic myelopathy: a comparative analysis with laminoplasty technique

The purpose of this study was to evaluate the effectiveness of selective laminectomy compared with laminoplasty for patients with multilevel cervical spondylotic myelopathy (CSM) by evaluating the radiological and clinical outcomes.

We retrospectively reviewed 67 patients with who underwent posterior laminectomy (LN) or laminoplasty (LP). LN was performed in 32 cases and LP in 35 cases. Radiologically, we evaluated the neutral C2-7 Cobb angle and range of motion (ROM) preoperatively and at final follow-up. Preoperative spinal cord compression and expansion of the spinal cord area postoperatively was evaluated using MRI. Differences in operating time and intraoperative and postoperative bleeding were analyzed. The clinical outcome was analyzed using the neck disability index (NDI) and the visual analog scale (VAS) for neck pain.

Surgery was performed on 2.04 segments in the LN group and 4.06 in the LP group. Cobb angle and ROM significantly decreased in the LN group at the final follow-up. No difference was found in the preoperative cord compression ratio or extent of expansion of the spinal cord postoperatively. The laminectomy group had a significantly shorter operation time and less intraoperative and postoperative bleeding. Both groups showed improved NDI, JOA score, and VAS for neck pain after surgery, with no significant differences.

Selective posterior laminectomy for the treatment of multilevel CSM showed advantages of shorter operation time and less blood loss, without a significant difference in clinical outcome, when compared with laminoplasty. However, postoperative kyphosis and decreased range of motion were limitations of laminectomy.