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Clinical Research
Available online 17 November 2021
Treatment of cervical myelopathy by posterior approach: Laminoplasty vs. laminectomy with posterior fixation, are there differences from a clinical and radiological point of view?
Tratamiento de la mielopatía cervical mediante abordaje posterior: laminoplastia vs. laminectomía con fijación posterior. ¿Existen diferencias desde el punto de vista clínico y radiológico?
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Víctor Rodríguez Domínguez
Corresponding author
vitivalde_11@hotmail.com

Corresponding author.
, María Luisa Gandía González, Pablo García Feijoo, Miguel Sáez Alegre, Catalina Vivancos Sánchez, Carlos Pérez López, Alberto Isla Guerrero
Servicio de Neurocirugía, Hospital Universitario La Paz, Madrid, Spain
Received 19 October 2020. Accepted 18 June 2021
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Tables (4)
Table 1. Nurick scale: clinical assessment of cervical myelopathy10.
Table 2. mJOA scale: clinical assessment of cervical myelopathy11.
Table 3. Preoperative variables studied expressed as a percentage.
Table 4. Variation analysis of pre- and post-intervention radiological measurements in both techniques.
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Abstract
Introduction

Cervical degenerative myelopathy is a variable and progressive degenerative disease caused by chronic compression of the spinal cord. Surgical approaches for the cervical spine can be performed anteriorly and/or posteriorly. Regarding the posterior approach, there are 2 fundamental techniques: laminoplasty and laminectomy with posterior fixation (LPF). There is still controversy concerning the technique in terms of outcome and complications. The aim of the present work is to analyze from the clinical and radiological point of view these 2 techniques: laminoplasty and LPF.

Materials and methods

A historical cohort of 39 patients was reviewed (12 LFP and 27 laminoplasty) including patients operated in a 10 years period at the Hospital Universitario La Paz with a follow-up of 12 months after surgery was carried out. The clinical results were analyzed and compared using the Nurick scale and the modified Japanese Orthopaedic Association Scale (mJOA) and the radiological results using the Cobb angle, Sagittal Vertical Axis, T1 Slope and alignment (measured by Cobb-T1 Sloppe).

Results

Significant differences were observed in the postoperative improvement of the Nurick scale (p = 0.008) and mJOA (p = 0.018) in the laminoplasty group. In LFP there is a tendency to a greater improvement, but statistical significance is not reached due to the low sample size of this group. No statistically significant differences were observed in the radiological variables. Regarding the total number of complications, a higher number was observed in the laminoplasty group (7 cases) versus LFP (one case), but no statistically significant differences were observed.

Conclusions

Laminoplasty and LFP are both safe and effective procedures in the treatment of cervical degenerative myelopathy. The findings of our study demonstrate statistically significant clinical improvement based on the Nurick and mJOA scales with laminoplasty. No significant differences in terms of complications or radiological variables were observed between the 2 techniques.

Keywords:
Cervical degenerative myelopathy
Laminoplasty
Laminectomy with posterior fixation
Nurick scale
mJOA scale
Cervical lordosis
Resumen
Introducción

La mielopatía cervical degenerativa (MCD) representa una entidad patológica producida por la estenosis del canal medular cervical, resultando en una compresión crónica de la médula espinal, variable y progresiva. El abordaje quirúrgico de la columna cervical puede realizarse por vía anterior y/o vía posterior. Respecto al abordaje posterior, existen 2 técnicas fundamentales: laminoplastia y laminectomía con fijación posterior (LFP). En la literatura actual existe controversia acerca de cuál de las dos técnicas permite obtener mejores resultados postoperatorios. El objetivo es el estudio de las diferencias entre laminoplastia y LFP desde el punto de vista clínico y radiológico.

Materiales y métodos

Se realiza un estudio de una cohorte histórica de 39 pacientes (12 LFP y 27 laminoplastia) intervenidos en un período de 10 años en el Hospital Universitario La Paz con un seguimiento de 12 meses tras la cirugía. Se analizan y comparan los resultados clínicos mediante la escala de Nurick y la Escala Japanese Orthopaedic Association modificada (mJOA) y los resultados radiológicos mediante el ángulo de Cobb, eje sagital vertical, T1 Slope y el alineamiento (medido mediante Cobb-T1 Sloppe).

Resultados

Se observan diferencias significativas en la mejoría postoperatoria de la escala Nurick (p = 0,008) y mJOA (p = 0,018) en el grupo de laminoplastia. En LFP se objetiva una tendencia a una mejoría mayor, pero no se alcanza la significación estadística debido al bajo tamaño muestral de este grupo. No se objetivan diferencias estadísticamente significativas en cuanto a la variables radiológicas. Respecto al total de complicaciones, se observó un número mayor en el grupo de laminoplastia (7 casos) frente a LFP (un caso), pero no se observaron diferencias estadísticamente significativas.

Conclusiones

La laminoplastia y la LFP son ambos procedimientos seguros y efectivos en el tratamiento de la mielopatía cervical degenerativa. Los hallazgos de nuestro estudio demuestran una mejoría clínica estadísticamente significativa en base a las escalas de Nurick y mJOA en el grupo de laminoplastia. No se observan diferencias significativas en cuanto a complicaciones ni variables radiológicas entre ambas técnicas.

Palabras clave:
Mielopatía cervical degenerativa
Laminoplastia
Laminectomía con fijación posterior
Escala de Nurick
Escala de mJOA
Lordosis cervical

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