Introduction: Degenerative cervical myelopathy (DCM) is a common cause of spinal cord dysfunction in adults, often requiring surgical intervention to alleviate compression and prevent neurological deterioration. Among posterior surgical approaches, laminectomy alone (LA) and laminectomy with fusion (LF) are widely used. LA offers benefits such as shorter operative times and preserved motion, yet it carries risks of postoperative kyphosis and instability. LF, with added instrumentation, aims to reduce these risks. This systematic review and meta-analysis aims to compare the clinical outcomes between LA and LF and establish the incidence of post-laminectomy kyphosis in LA.
Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. We searched PubMed, Scopus, Embase, Web of Science, and Medline for studies comparing LA and LF for DCM. Outcomes assessed included postoperative kyphosis, neurological recovery (mJOA/JOA scores), patient-reported outcomes, and complication rates. Meta-analyses were performed using random-effects models.
Results: A total of 25 studies, including 3,140 patients (2,165 with LA and 975 with LF), met the inclusion criteria. Pooled data showed that the incidence of post-laminectomy kyphosis in the LA group was 2.02 events per 100 person-years (95% CI: 1.26–2.78). No significant differences were observed between LA and LF in pre-to-post-operative changes in mJOA/JOA scores (MD: 0.13, 95% CI: -0.97 to 1.22), NDI (MD: 3.05, 95% CI: -3.11 to 9.22), or neck pain scores (MD: -0.10, 95% CI: -0.89 to 0.69). Complication rates were comparable between groups, with an odds ratio of 0.50 (95% CI: 0.17 to 1.51) for LA compared to LF.
Conclusion : Although LA is associated with a yearly kyphosis incidence of approximately 2%, functional outcomes, pain scores, and complication rates are similar between LA and LF. These findings suggest that both are viable options for DCM treatment. However, further randomized trials are needed to better delineate the benefits of each approach and optimize patient selection
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