21. The safety and efficacy of cervical laminectomy and fusion vs cervical laminoplasty surgery in degenerative cervical myelopathy: a prospective randomized trial

BACKGROUND CONTEXT There is a lack of evidence of whether degenerative cervical myelopathy (DCM) is best treated via cervical laminoplasty or cervical laminectomy with lateral mass fusion due to the lack of prospective randomized studies that are well designed. PURPOSE We conducted the largest prospective randomized trial to date to determine the comparative effectiveness and safety of both approaches. STUDY DESIGN/SETTING In this prospective, randomized trial, we randomly assigned patients who had symptoms or signs of DCM to undergo either cervical laminectomy and lateral mass fixation (CLF) or cervical laminoplasty (CLP). PATIENT SAMPLE A total of 39 patients (mean age, 55.7±5.5 years, 69.2% men) underwent prospective randomization. OUTCOME MEASURES The primary outcome measures were the change in the visual analog scale (VAS), Neck Disability Index (NDI), modified Japanese Orthopedic Association (mJOA) score, and Nurick's myelopathy grading one year after surgery. The secondary outcome measures were the intraoperative, postoperative complications, hospital stay, C2-7 Cobb's angle, and Odom's criteria. METHODS In this prospective, randomized trial, we randomly assigned patients who had symptoms or signs of DCM to undergo either cervical laminectomy and lateral mass fixation (CLF) or cervical laminoplasty (CLP). The primary outcome measures were the change in the visual analogue scale (VAS), neck disability index (NDI), modified Japanese Orthopedic Association (mJOA) score, and Nurick's myelopathy grading one year after surgery. The secondary outcome measures were the intraoperative, postoperative complications, hospital stay, C2-7 Cobb's angle, and Odom's criteria. The follow-up period was at least one year. RESULTS There was a significantly greater improvement in the NDI and VAS in the CLF group at one year (p CONCLUSIONS Among patients with multilevel DCM, the CLF approach was significantly better regarding the postoperative pain, NDI, and one-year Cobb's angle improvement, while the posterior approach was significantly better in terms of shorter hospital stay and operative time. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.