Laminoplasty Is IT for Some Multilevel Myelopathy

Vanderbilt and Emory Universities’ researchers have found that for the right patients, laminoplasty is the better surgical option than fusion-based alternatives for treating neck pain.

The study, “Laminoplasty Does Not Lead to Worsening Axial Neck Pain in the Properly Selected Patient With Cervical Myelopathy: A Comparison With Laminectomy and Fusion,” appears in the December 15, 2017 edition of Spine.

Co-author John M. Rhee, M.D., member of the Department of Orthopaedic Surgery at Emory University in Atlanta, told OTW, “Laminoplasty is a proven, effective operation for the treatment of multilevel cervical myelopathy.”

“However, one criticism leveled against laminoplasty is that it may cause axial neck pain postoperatively. Previous studies have had conflicting results in this regard.”

“Regardless, our clinical observation has been that laminoplasty does not create neck pain in myelopathic patients who do not present with significant axial pain preoperatively if lordotic sagittal alignment is maintained.”

“In this study, we sought to compare patient reported neck pain and myelopathy outcomes after laminoplasty versus laminectomy with fusion in patients with multilevel cervical myelopathy.”

“All data was prospectively collected, but patients were selected to undergo laminoplasty versus laminectomy with fusion by the treating surgeon. Those without substantial preoperative axial neck pain complaints and who demonstrated neutral to lordotic sagittal alignment were treated with laminoplasty; those who did not meet these criteria were treated with laminectomy with fusion instead.”

“Laminoplasty did not lead to worsening axial neck pain scores at a minimum of one year postoperatively. In fact, there was a very slight, though not significant, decrease in axial neck pain scores after laminoplasty. Both laminoplasty and laminectomy with fusion were associated with significantly improved, similar mJOA [modified Japanese Orthopedic Association] scores.”

“Many patients with multilevel myelopathy have appropriate sagittal alignment and do not have substantial neck pain complaints. In such patients, laminoplasty did not create postoperative axial neck pain but did significantly improve myelopathy outcomes.”

“Laminoplasty is not indicated in every patient with multilevel myelopathy. However, in those without substantial axial pain and who present with favorable alignment, we recommend it as the surgical procedure of choice over its fusion-based alternatives. In the appropriately selected patient, laminoplasty is the preferred option over its fusion-based alternatives since it does not create postoperative neck pain yet achieves similar neurologic outcomes while completely avoiding fusion.”