A Comparison of Clinical Outcomes Between Anterior Cervical Discectomy and Fusion Versus Posterior Cervical Laminoplasty for Multilevel Cervical Myelopathy.

Autor:	Lee Y; Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA., Trenchfield D; Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA., Berthiaume E; Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA., Tomlak A; Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA., Narayanan R; Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA., Brush P; Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA., Heard J; Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA., Maddy K; Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA., Issa T; Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA., Lambrechts M; Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO., Kaye ID; Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA., Mangan J; Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA., Grasso G; Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Neurosurgical Clinic, University of Palermo, Via del Vespro, Palermo, Italy., Canseco J; Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA., Vaccaro A; Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA., Kepler C; Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA., Schroeder G; Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA., Hilibrand A; Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA.
Jazyk:	angličtina
Zdroj:	Clinical spine surgery [Clin Spine Surg] 2024 Jun 17. Date of Electronic Publication: 2024 Jun 17.
DOI:	10.1097/BSD.0000000000001634
Abstrakt:	Study Design: Retrospective Cohort. Objective: To compare patient-reported outcomes and surgical outcomes after anterior cervical discectomy and fusion (ACDF) versus cervical laminoplasty for multilevel cervical spondylotic myelopathy. Background: Treatment options for multilevel cervical spondylotic myelopathy include ACDF and cervical laminoplasty. Given that the literature has been mixed regarding the optimal approach, especially in patients without kyphosis, there is a need for additional studies investigating outcomes between ACDF and cervical laminoplasty. Methods: A retrospective review was conducted of adult patients undergoing 3 or 4-level surgery. Patients with preoperative kyphosis based on C2-C7 Cobb angles were excluded. The electronic medical record and institutional databases were reviewed for baseline characteristics, surgical outcomes, and patient-reported outcomes. Results: A total of 101 patients who underwent ACDF and 52 patients who underwent laminoplasty were included in the study. The laminoplasty cohort had a higher overall Charlson Comorbidity Index (3.10 ± 1.43 vs 2.39 ± 1.57, P = 0.011). Both groups had a comparable number of levels decompressed, C2-C7 lordosis, and diagnosis of myelopathy versus myeloradiculopathy. Patients who underwent laminoplasty had a longer length of stay (2.04 ± 1.15 vs 1.48 ± 0.70, P = 0.003) but readmission, complication, and revision rates were similar. Both groups had similar improvement in myelopathy scores (∆modified Japanese Orthopedic Association: 1.11 ± 3.09 vs 1.06 ± 3.37, P = 0.639). ACDF had greater improvement in Neck Disability Index (∆Neck Disability Index: -11.66 ± 19.2 vs -1.13 ± 11.2, P < 0.001), neck pain (∆Visual Analog Scale-neck: -2.69 ± 2.78 vs -0.83 ± 2.55, P = 0.003), and arm pain (∆Visual Analog Scale-arm: -2.47 ± 3.15 vs -0.48 ± 3.19, P = 0.010). These findings persisted in multivariate analysis except for Neck Disability Index. Conclusion: ACDF and cervical laminoplasty appear equally efficacious at halting myelopathic progression. However, patients who underwent ACDF had greater improvements in arm pain at 1 year postoperatively. Longitudinal studies evaluating the efficacy of laminoplasty to mitigate adjacent segment disease are indicated to establish a robust risk-benefit assessment for these 2 procedures. Level of Evidence: III. Competing Interests: Schroeder has received funds to travel from AO Spine and Medtronic. Dr Vaccaro has consulted or has done independent contracting for DePuy, Medtronic, Stryker Spine, Globus, Stout Medical, Gerson Lehrman Group, Guidepoint Global, Medacorp, Innovative Surgical Design, Orthobullets, Ellipse, and Vertex. He has also served on the scientific advisory board/board of directors/committees for Flagship Surgical, AO Spine, Innovative Surgical Design, and Association of Collaborative Spine Research. Dr Vaccaro has received royalty payments from Medtronic, Stryker Spine, Globus, Aesculap, Thieme, Jaypee, Elsevier, and Taylor Francis/Hodder and Stoughton. He has stock/stock option ownership interests in Replication Medica, Globus, Paradigm Spine, Stout Medical, Progressive Spinal Technologies, Advanced Spinal Intellectual Properties, Spine Medica, Computational Biodynamics, Spinology, In Vivo, Flagship Surgical, Cytonics, Bonovo Orthopaedics, Electrocore, Gamma Spine, Location Based Intelligence, FlowPharma, R.S.I., Rothman Institute and Related Properties, Innovative Surgical Design, and Avaz Surgical. He has also served as deputy editor/editor of Spine. In addition, Dr Vaccaro has also provided expert testimony. He has also served as deputy editor/editor of Clinical Spine Surgery. The remaining authors declare no conflict of interest. (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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