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No Difference in Complications or Reoperation Rates Between Laminoplasty Versus Laminectomy and Fusion for Cervical
Rohan Vemu1, Alexis Watson2, Bijan Dehghani3
1Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, TX.
Study Design:
A retrospective database study.
Objectives:
To compare postoperative complications and reoperation rates between posterior cervical laminectomy and fusion (LF) and laminoplasty (LP) in myelopathy patients with concomitant Parkinson disease (PD).
Summary Of Background Data:
LF and LP are both widely accepted treatments for cervical spondylotic myelopathy (CSM), although the impact of coexisting Parkinson disease on outcomes is unclear. Given the neurodegenerative nature of PD, there is concern for development of kyphosis after laminoplasty due to muscle weakness and lack of coordination.
Methods:
CSM patients with a coexisting diagnosis of PD who underwent primary LF or LP were identified using International Classification of Diseases (ICD) diagnosis codes and current procedural terminology (CPT) codes in the PearlDiver database. Patients were excluded for prior cervical surgery, trauma, tumor, infection, deformity, and anterior or staged procedures. Postoperative complications, including infection, transfusion requirement, kyphosis, and pseudarthrosis, were evaluated and compared between groups along with reoperation rates at 10 years. Statistical significance was assessed by χ2, Fisher exact, and t tests as appropriate.
Results:
A total of 1117 LF and 169 LP patients met inclusion criteria. The median age range was 70-79 years for both groups, and the majority were of moderate risk on Charlson Comorbidity Index. Complication rates were low and similar between groups. No difference in postoperative cervical kyphosis was observed. At 10 years postoperatively, 1.78% of LP patients and 3.85% of LF patients required additional cervical surgery, although this was not statistically significant (P=0.07).
Conclusions:
Complications and reoperation rates after laminectomy and fusion and laminoplasty in CSM patients with Parkinson disease were relatively low. Reoperation rates were similar between groups with a trend towards lower rates in laminoplasty, indicating that neurodegenerative disorders such as Parkinson disease do not always necessitate fusion.
Level Of Evidence:
Level III.