Multifactor analysis on the outcomes of cervical spondylotic myelopathy with expansive open-door laminoplasty

Prevalence of complications after surgery in treatment for cervical compressive myelopathy: A meta-analysis for last decade

PURPOSE

We aim to perform a meta-analysis on prevalence of all kinds of operation-related complications following surgery treating cervical compressive myelopathy (CCM) and to provide reference for surgeons making surgical plan.

METHODS

An extensive search of literature was performed in PubMed/MEDLINE, Embase, the Cochrane library, CNKI, and WANFANG databases on incidence of operation-related complications from January 2007 to November 2016. Data was calculated and data analysis was conducted with STATA 12.0 and Revman 5.3.

RESULTS

A total of 107 studies included 1705 of 8612 patients (20.1%, 95% CI 17.3%-22.8%) on overall complications. The incidence of C5 plasy, cerebrospinal fluid (CSF), infection, axial pain, dysphagia, hoarseness, fusion failure, graft subsidence, graft dislodgment, and epidural hematoma is 5.3% (95% CI 4.3%-6.2%), 1.9% (95% CI 1.3%-2.4%), 2.8% (95% CI 1.7%-4.0%), 15.6% (95% CI 11.7%-19.5%), 16.8% (95% CI 13.6%-19.9%), 4.0% (95% CI 2.3%-5.7%), 2.6% (95% CI 0.2%-4.9%), 3.7% (95% CI 2.0%-5.5%), 3.4% (95% CI 2.0%-4.8%), 1.1% (95% CI 0.7%-1.5%), respectively. Patients with ossification of posterior longitudinal ligament (OPLL) (6.3%) had a higher prevalence of C5 plasy than those with cervical spondylotic myelopathy (CSM) (4.1%), and a similar trend in CSF (12.2% vs 0.9%). Individuals after laminectomy and fusion (LF) had highest rate of C5 plasy (15.2%), while those who underwent anterior cervical discectomy and fusion (ACDF) had the lowest prevalence (2.0%). Compared with patients after other surgical options, individuals after anterior cervical corpectomy and fusion (ACCF) have the highest rate of CSF (4.2%), infection (14.2%), and epidural hematoma (3.1%). Patients after ACDF (4.8%) had a higher prevalence of hoarseness than those with ACCF (3.0%), and a similar trend for dysphagia between anterior corpectomy combined with discectomy (ACCDF) and ACCF (16.8% vs 9.9%).

CONCLUSIONS

Based on our meta-analysis, patients with OPLL have a higher incidence of C5 palsy and CSF. Patients after LF have a higher incidence of C5 palsy, ACCDF have a higher incidence of dysphagia, ACCF have a higher incidence of CSF and infection and ACDF have a higher incidence of hoarseness. These figures may be useful in the estimation of the probability of complications following cervical surgery.

Effect and Prognostic Factors of Laminoplasty for Cervical Myelopathy With an Occupying Ratio Greater Than 50%

STUDY DESIGN

A retrospective study.

OBJECTIVE

The aim of this study was to evaluate the efficacy of laminoplasty for the treatment of patients with an occupying ratio greater than 50% and to determine possible factors related to surgical outcome of posterior decompression.

SUMMARY OF BACKGROUND DATA

Little data are available about effect and prognostic factors of laminoplasty for cervical myelopathy with an occupying ratio greater than 50%.

METHODS

Fifty-five consecutive patients with an occupying ratio greater than 50% who underwent cervical laminoplasty between January 2005 and December 2010 were reviewed in this study. Patients with cervical kyphosis were excluded. Clinical and radiologic outcomes were assessed. Univariate analysis was used to investigate the relationship between recovery rate and the age, duration of symptoms, preoperative Japan Orthopedic Association (JOA) score, posterior shift of the spinal cord, preoperative cervical lordosis, spinal cord compression ratio, and follow-up period. Multivariate linear regression analysis was used to determine the best surgical outcome predictor.

RESULTS

All patients maintained cervical lordosis. Average JOA score improved from 10.7 ± 1.7 points preoperatively to 14.0 ± 1.4 points at the last follow-up. The mean rate of recovery was 51.4 ± 25.7%. Final recovery rates showed 6 excellent results, 29 good results, 18 fair results, and 2 poor results. Univariate analysis showed significant correlation between the recovery rate and the spinal cord compression ratio, duration of symptoms, and posterior movement of the spinal cord. The multivariate linear regression analysis showed that the best surgical outcome predictor was the spinal cord compression ratio (β = 0.698, P < 0.001). R-square of the final multiple linear regression model was 0.509.

CONCLUSION

Laminoplasty can still be considered as a decompressive pattern for patients with a high occupying ratio greater than 50%. The spinal cord compression ratio, duration of symptoms, and posterior movement of the spinal cord play important roles in recovery rate. The best surgical outcome predictor is the spinal cord compression ratio.

LEVEL OF EVIDENCE

4.

Cervical laminoplasty developments and trends, 2003-2013: a systematic review

OBJECT

Despite extensive clinical experience with laminoplasty, the efficacy of the procedure and its advantages over laminectomy remain unclear. Specific clinical elements, such as incidence or progression of kyphosis, incidence of axial neck pain, postoperative cervical range of motion, and incidence of postoperative C-5 palsies, are of concern. The authors sought to comprehensively review the laminoplasty literature over the past 10 years while focusing on these clinical elements.

METHODS

The authors conducted a literature search of articles in the Medline database published between 2003 and 2013, in which the terms "laminoplasty," "laminectomy," and "posterior cervical spine procedures" were used as key words. Included was every single case series in which patient outcomes after a laminoplasty procedure were reported. Excluded were studies that did not report on at least one of the above-mentioned items.

RESULTS

A total of 103 studies, the results of which contained at least 1 of the prespecified outcome variables, were identified. These studies reported 130 patient groups comprising 8949 patients. There were 3 prospective randomized studies, 1 prospective nonrandomized alternating study, 15 prospective nonrandomized data collections, and 84 retrospective reviews. The review revealed a trend for the use of miniplates or hydroxyapatite spacers on the open side in Hirabayashi-type laminoplasty or on the open side in a Kurokawa-type laminoplasty. Japanese Orthopaedic Association (JOA) scoring was reported most commonly; in the 4949 patients for whom a JOA score was reported, there was improvement from a mean (± SD) score of 9.91 (± 1.65) to a score of 13.68 (± 1.05) after a mean follow-up of 44.18 months (± 35.1 months). The mean preoperative and postoperative C2-7 angles (available for 2470 patients) remained stable from 14.17° (± 0.19°) to 13.98° (± 0.19°) of lordosis (average follow-up 39 months). The authors found significantly decreased kyphosis when muscle/posterior element-sparing techniques were used (p = 0.02). The use of hardware in the form of hydroxyapatite spacers or miniplates did not influence the progression of deformity (p = 0.889). An overall mean (calculated from 2390 patients) of 47.3% loss of range of motion was reported. For the studies that used a visual analog scale score (totaling 986 patients), the mean (cohort size-adjusted) postoperative pain level at a mean follow-up of 29 months was 2.78. For the studies that used percentages of patients who complained of postoperative axial neck pain (totaling 1249 patients), the mean patient number-adjusted percentage was 30% at a mean follow-up of 51 months. The authors found that 16% of the studies that were published in the last 10 years reported a C-5 palsy rate of more than 10% (534 patients), 41% of the studies reported a rate of 5%-10% (n = 1006), 23% of the studies reported a rate of 1%-5% (n = 857), and 12.5% reported a rate of 0% (n = 168).

CONCLUSIONS

Laminoplasty remains a valid option for decompression of the spinal cord. An understanding of the importance of the muscle-ligament complex, plus the introduction of hardware, has led to progress in this type of surgery. Reporting of outcome metrics remains variable, which makes comparisons among the techniques difficult.