Comparison of Clinical and Radiologic Outcomes in Laminectomy with Fusion, Laminoplasty, and Laminoplasty with Fusion for Cervical Myelopathy

Introduction: Cervical myelopathy often necessitates surgical intervention when conservative treatments fail. Common posterior decompression surgeries include laminectomy with fusion (LF), laminoplasty (LP), and laminoplasty with fusion (LPF), each with specific advantages and limitations. LF provides stability but may lead to issues like dural adhesion due to lamina removal. LP preserves structures but risks cervical kyphosis. LPF was developed to address these limitations. This study compares clinical and radiologic outcomes of these three techniques, focusing on the effectiveness and stability of LPF.

Methods: This retrospective study analyzed 60 patients who underwent LF, LP, or LPF from 2012 to 2023, with 20 patients in each group. Radiologic assessments included C2-7 sagittal vertical axis (SVA), T1 slope, C2-7 Cobb’s angle, and spinal canal length to analyze cervical alignment changes. Fusion success was determined based on postoperative X-rays showing less than 4 degrees in Cobb’s angle change. Clinical outcomes were evaluated using Japanese Orthopedic Association (JOA) and Visual Analog Scale (VAS) scores, with recovery rates calculated from these scores. Operation time, blood loss, and complications were recorded.

Results: The LPF group showed greater improvements in JOA and VAS scores than the LF and LP groups, indicating better neurological recovery. Radiologic outcomes demonstrated that LPF had less postoperative loss in Cobb’s angle and lower SVA change than LP, supporting improved alignment stability. The LPF group also had a higher fusion success rate than LF, with 85% of cases showing less than 4 degrees change in Cobb’s angle compared to 55% in LF. Both LPF and LP achieved similar spinal canal expansion. However, LPF required longer surgery time and had greater blood loss.

Conclusion : LPF effectively combines the benefits of LF and LP, showing superior outcomes in preventing kyphosis, achieving higher fusion rates, and enhancing neurological recovery. Although LPF requires longer surgery time and more blood loss, its stability and recovery advantages make it a promising alternative for treating cervical myelopathy.