Clinical and Radiological Outcomes of Laminectomy With Fusion Versus Laminoplasty in Multilevel Cervical Myelopathy:...

Study DesignSystematic review and meta-analysis.ObjectivesTo compare the efficacy and safety of laminoplasty (LP) versus laminectomy with instrumented fusion (LF) for multilevel degenerative cervical myelopathy (DCM).MethodsFollowing PRISMA 2020 guidelines, we searched PubMed, ScienceDirect, and Cochrane Library for studies. Primary outcomes included functional recovery (mJOA), disability (NDI), neck pain (VAS), and quality of life (SF-36). Secondary outcomes included radiographic markers, perioperative metrics, and complications. Risk of bias was assessed using RoB 2.0 and the Newcastle-Ottawa Scale (NOS).ResultsEighteen studies involving 1,488 patients were included. Outcomes were broadly comparable. mJOA showed a statistically significant but small difference (MD: -0.34; 95% CI: -0.43 to -0.25; p < 0.00001), while NDI did not differ significantly (p = 0.42). LF was associated with a statistically significant but clinically small reduction in VAS neck pain (MD: -0.18; 95% CI: -0.32 to -0.05; p = 0.007). LP preserved greater cervical range of motion (p = 0.0005) and was associated with lower T1 slope (p = 0.0004), lower blood loss (p = 0.002), and shorter operative time (p = 0.002), although perioperative differences were modest. LF was associated with higher C5 palsy risk (OR: 3.30; 95% CI: 1.88-5.78; p < 0.0001). Hospital stay, reoperation rate, and SF-36 did not differ significantly.ConclusionLF and LP provide broadly comparable functional outcomes in multilevel DCM. Because included studies were largely observational and several outcomes were heterogeneous, procedure selection should be individualized according to sagittal alignment, instability, OPLL burden, motion-preservation goals, axial pain, and surgical risk.