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Published on: July 15, 2021
Incidence of Tetraplegia After Cervical Laminectomy Versus Laminoplasty: A Propensity Score Matched Analysis Using US
Teleale Fikru Gebeyehu1, Yashvi Shah1,2, Lucas Gorial Garmo3
1Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
Abstract:
Study DesignRetrospective cohort study.ObjectivesTo identify and compare the understudied, rare, and catastrophic incidence of tetraplegia in patients undergoing laminectomy versus laminoplasty for degenerative cervical conditions.MethodsWe analyzed propensity-score-matched laminectomy (with or without fusion) and laminoplasty cohorts from the TriNetX US Collaborative Network database. Primary outcome was tetraplegia (complete or incomplete) after 2, 7, 30, 180 and 365 days. Secondary outcome was death in 12 months. Patient count was calculated with outcome, risk, odds and hazard ratios, and Kaplan-Meier analysis (KMA).ResultsAverage age after matching was 61.5 years. Most patients were Caucasian (∼72%) and had spinal stenosis (94%), and/or spondylosis (∼71%) or disc disorder (∼29%) with myelopathy. KMA showed incomplete tetraplegia predominated, and occurrence was very rare for both procedures. Occurrence (Risk, %) of tetraplegia for laminectomy of C1-C4 in 3,919 patients were 21 (0.5), 48 (1.2), 70 (1.8), 84 (2.1) and 87 (2.2) at the established time points, versus 13 (0.3), 27 (0.7), 38 (1), 43 (1.1) and 44 (1.1) for laminoplasty in 3,937 patients with significance for risk difference noted 7 days onwards. Occurrence (Risk, %) for laminectomy at C5-C7 in 3,934 patients were 11 (0.3), 25 (0.6), 41 (1), 53 (1.3), and 55 (1.4) versus 13 (0.3), 22 (0.6), 27 (0.7), 29 (0.7) and 30 (0.8) for laminoplasty in 3,948 patients with significance for the difference on 180 and 365 days. Occurrence (Risk, %) of mortality at 12 months was 108 (2.7) for laminectomy in 3,952 patients vs 62 (1.6) for laminoplasty in 3,947 patients (P = 0.0004).ConclusionBoth procedures had very low incidence of tetraplegia. Laminectomy was associated with marginally increased risk of incomplete tetraplegia compared to laminoplasty, especially for C1-C4 region. Although minimal, risk of tetraplegia increased over time as count of patients with tetraplegia cumulatively increased.
