Laminoplasty versus Laminectomy and Fusion to Treat Cervical Spondylotic Myelopathy: Outcomes of the Prospective Multicenter AOSpine International CSM Study

Introduction Recent studies conducted in North America have demonstrated the benefits of surgical treatment for symptomatic CSM. However, differences in pathology, comorbidities, treatment approaches, and cultural response to treatment may affect the generalizability of these findings at the global level.Patients and Methods Patients receiving surgery for clinically symptomatic CSM were enrolled in a prospective multicenter, cohort study which is continuing to accrue patients at 16 sites in Europe, Asia, and North and South America. Patients included were a part of a larger ongoing prospective observational study that has enrolled 492 patients with CSM involving 16 clinical sites in Europe, Asia, and North and South America. Of those, 108 received laminectomy and fusion, and 66 received laminoplasty. The choice of surgical approach was at the discretion of the surgeon. Outcome measures were mJOA, the Nurick scale, NDI, and the SF36 PCS and MCS component scores.Results Average age was 60.2 years (SD 10.8), 29.8% were female. Patients treated with laminectomy and fusion had more levels operated (5.0 vs. 4.4, p< 0.01), shorter length of stay (7.7 vs. 15.7 days, p< 0.01), and less severe neurologic impairment measured by mJOA (12.6 vs. 11.2, p< 0.01). There were no differences in age, baseline NDI, SF36v2 PCS, and SF36v2 MCS. At 12-month follow-up, there were no differences in neurologic and functional outcomes for laminoplasty compared with laminectomy and fusion; mJOA (3.0 and 2.3, respectively, p= 0.15). Moreover, there were no differences in NDI (13.3 and 12.0, respectively, p= 0.71), SF-36v2 PCS (8.5 and 7.7, respectively, p= 0.66), and SF-36v2 MCS (7.9 and 6.9, respectively, p= 0.56).Conclusion Patients undergoing laminectomy and fusion and laminoplasty surgery for CSM show similar improvements in generic and disease-specific outcome measures allowing for baseline differences in clinical presentation between the two groups of patients. Longer-term follow-up will be required to determine whether any differences in outcome between the two forms of treatment emerge.