Abstract
Background
Surgical strategy for multilevel cervical myelopathy resulting from cervical spondylotic myelopathy (CSM) or ossification of posterior longitudinal ligament (OPLL) still remains controversial. There are still questions about the relative benefit and safety of direct decompression by anterior corpectomy (CORP) versus indirect decompression by posterior laminoplasty (LAMP).
Objective
To perform a systematic review and meta-analysis evaluating the results of anterior CORP compared with posterior LAMP for patients with multilevel cervical myelopathy.
Methods
Systematic review and meta-analysis of cohort studies comparing anterior CORP with posterior LAMP for the treatment of multilevel cervical myelopathy due to CSM or OPLL from 1990 to December 2012. An extensive search of literature was performed in Pubmed, Embase, and the Cochrane library. The quality of the studies was assessed according to GRADE. The following outcome measures were extracted: pre- and postoperative Japanese orthopedic association (JOA) score, neurological recovery rate (RR), surgical complications, reoperation rate, operation time and blood loss. Two reviewers independently assessed each study for quality and extracted data. Subgroup analysis was conducted according to the mean number of surgical segments.
Results
A total of 12 studies were included in this review, all of which were prospective or retrospective cohort studies with relatively low quality. The results indicated that the mean JOA score system for cervical myelopathy and the neurological RR in the CORP group were superior to those in the LAMP group when the mean surgical segments were <3, but were similar between the two groups in the case of the mean surgical segments equal to 3 or more. There was no statistical difference in the surgical complication rate between the two groups when the mean surgical segments <3, but were significantly higher incidences of surgical complications and complication-related reoperation in the CORP group compared with the LAMP group in the case of the mean surgical segments equal to 3 or more. Besides, the operation time in the CORP group was longer than that in the LAMP group, and the average blood loss was significantly more in the CORP group compared with the LAMP group.
Conclusion
Based on the results above, anterior CORP and fusion is recommended for the treatment of multilevel cervical myelopathy when the involved surgical segments were <3. Given the higher rates of surgical complications and complication-related reoperation and the higher surgical trauma associated with multilevel CORP, however, it is suggested that posterior LAMP may be the preferred method of treatment for multilevel cervical myelopathy when the involved surgical segments were equal to 3 or more. In addition, taking the limitations of this study into consideration, it was still not appropriate to draw a strong conclusion claiming superiority for CORP or LAMP. A well-designed, prospective, randomized controlled trial is necessary to provide objective data on the clinical results of both procedures.
Similar content being viewed by others
References
Sugrue PA, McClendon JJ, Halpin RJ, Liu JC, Koski TR, Ganju A (2011) Surgical management of cervical ossification of the posterior longitudinal ligament: natural history and the role of surgical decompression and stabilization. Neurosurg Focus 30:E3
Witwer BP, Trost GR (2007) Cervical spondylosis: ventral or dorsal surgery. Neurosurgery 60:S130–S136
Saunders RL, Pikus HJ, Ball P (1998) Four-level cervical corpectomy. Spine (Phila Pa 1976) 23:2455–2461
Tsuji H (1982) Laminoplasty for patients with compressive myelopathy due to so-called spinal canal stenosis in cervical and thoracic regions. Spine (Phila Pa 1976) 7:28–34
Hosono N, Yonenobu K, Ono K (1996) Neck and shoulder pain after laminoplasty. A noticeable complication. Spine (Phila Pa 1976) 21:1969–1973
Chen Y, Guo Y, Lu X, Chen D, Song D, Shi J, Yuan W (2011) Surgical strategy for multilevel severe ossification of posterior longitudinal ligament in the cervical spine. J Spinal Disord Tech 24:24–30
Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA 283:2008–2012
Furlan AD, Pennick V, Bombardier C, van Tulder M (2009) 2009 updated method guidelines for systematic reviews in the Cochrane back review group. Spine (Phila Pa 1976) 34:1929–1941
Balshem H, Helfand M, Schunemann HJ, Oxman AD, Kunz R, Brozek J, Vist GE, Falck-Ytter Y, Meerpohl J, Norris S, Guyatt GH (2011) GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol 64:401–406
Hirabayashi K, Miyakawa J, Satomi K, Maruyama T, Wakano K (1981) Operative results and postoperative progression of ossification among patients with ossification of cervical posterior longitudinal ligament. Spine (Phila Pa 1976) 6:354–364
Yonenobu K, Hosono N, Iwasaki M, Asano M, Ono K (1992) Laminoplasty versus subtotal corpectomy. A comparative study of results in multisegmental cervical spondylotic myelopathy. Spine (Phila Pa 1976) 17:1281–1284
Wada E, Suzuki S, Kanazawa A, Matsuoka T, Miyamoto S, Yonenobu K (2001) Subtotal corpectomy versus laminoplasty for multilevel cervical spondylotic myelopathy: a long-term follow-up study over 10 years. Spine (Phila Pa 1976) 26:1443–1448
Edwards CN, Heller JG, Murakami H (2002) Corpectomy versus laminoplasty for multilevel cervical myelopathy: an independent matched-cohort analysis. Spine (Phila Pa 1976) 27:1168–1175
Wang B, Liu H, Wang H, Zhou D (2006) Segmental instability in cervical spondylotic myelopathy with severe disc degeneration. Spine (Phila Pa 1976) 31:1327–1331
Masaki Y, Yamazaki M, Okawa A, Aramomi M, Hashimoto M, Koda M, Mochizuki M, Moriya H (2007) An analysis of factors causing poor surgical outcome in patients with cervical myelopathy due to ossification of the posterior longitudinal ligament: anterior decompression with spinal fusion versus laminoplasty. J Spinal Disord Tech 20:7–13
Iwasaki M, Okuda S, Miyauchi A, Sakaura H, Mukai Y, Yonenobu K, Yoshikawa H (2007) Surgical strategy for cervical myelopathy due to ossification of the posterior longitudinal ligament: Part 2: Advantages of anterior decompression and fusion over laminoplasty. Spine (Phila Pa 1976) 32:654–660
Lee SH, Ahn Y, Lee JH (2008) Laser-assisted anterior cervical corpectomy versus posterior laminoplasty for cervical myelopathic patients with multilevel ossification of the posterior longitudinal ligament. Photomed Laser Surg 26:119–127
Shibuya S, Komatsubara S, Oka S, Kanda Y, Arima N, Yamamoto T (2010) Differences between subtotal corpectomy and laminoplasty for cervical spondylotic myelopathy. Spinal Cord 48:214–220
Gandhoke G, Wu JC, Rowland NC, Meyer SA, Gupta C, Mummaneni PV (2011) Anterior corpectomy versus posterior laminoplasty: is the risk of postoperative C-5 palsy different? Neurosurg Focus 31:E12
Hirai T, Okawa A, Arai Y, Takahashi M, Kawabata S, Kato T, Enomoto M, Tomizawa S, Sakai K, Torigoe I, Shinomiya K (2011) Middle-term results of a prospective comparative study of anterior decompression with fusion and posterior decompression with laminoplasty for the treatment of cervical spondylotic myelopathy. Spine (Phila Pa 1976) 36:1940–1947
Sakai K, Okawa A, Takahashi M, Arai Y, Kawabata S, Enomoto M, Kato T, Hirai T, Shinomiya K (2012) Five-year follow-up evaluation of surgical treatment for cervical myelopathy caused by ossification of the posterior longitudinal ligament: a prospective comparative study of anterior decompression and fusion with floating method versus laminoplasty. Spine (Phila Pa 1976) 37:367–376
Guyatt GH, Oxman AD, Sultan S, Glasziou P, Akl EA, Alonso-Coello P, Atkins D, Kunz R, Brozek J, Montori V, Jaeschke R, Rind D, Dahm P, Meerpohl J, Vist G, Berliner E, Norris S, Falck-Ytter Y, Murad MH, Schunemann HJ (2011) GRADE guidelines: 9. Rating up the quality of evidence. J Clin Epidemiol 64:1311–1316
Fraser JF, Hartl R (2007) Anterior approaches to fusion of the cervical spine: a meta-analysis of fusion rates. J Neurosurg Spine 6:298–303
Kimura I, Shingu H, Nasu Y (1995) Long-term follow-up of cervical spondylotic myelopathy treated by canal-expansive laminoplasty. J Bone Joint Surg Br 77:956–961
Sakaura H, Hosono N, Mukai Y, Fujimori T, Iwasaki M, Yoshikawa H (2010) Preservation of muscles attached to the C2 and C7 spinous processes rather than subaxial deep extensors reduces adverse effects after cervical laminoplasty. Spine (Phila Pa 1976) 35:E782–E786
Wang L, Song Y, Liu L, Liu H, Kong Q, Li T, Zeng J (2012) Clinical outcomes of two different types of open-door laminoplasties for cervical compressive myelopathy: a prospective study. Neurol India 60:210–216
Kotani Y, Abumi K, Ito M, Sudo H, Takahata M, Nagahama K, Iwata A, Minami A (2012) Impact of deep extensor muscle-preserving approach on clinical outcome of laminoplasty for cervical spondylotic myelopathy: comparative cohort study. Eur Spine J 21:1536–1544
Asano S, Nohara Y, Kiya T et al (1999) Postoperative management without immobilization of the cervical spine in patients undergoing cervical laminoplasty: effects on clinical and radiological outcomes [abstract]. In: Presented at the 27th Annual Meeting of the Cervical Spine Society, Seattle. 16 Dec 1999
Kawaguchi Y, Kanamori M, Ishiara H, Nobukiyo M, Seki S, Kimura T (2003) Preventive measures for axial symptoms following cervical laminoplasty. J Spinal Disord Tech 16:497–501
Chen Y, Liu X, Chen D, Wang X, Yuan W (2012) Surgical strategy for ossification of the posterior longitudinal ligament in the cervical spine. Orthopedics 35:e1231–e1237
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Additional information
X. Liu and S. Min equally contributed to this work and should be considered as co-first authors.
Rights and permissions
About this article
Cite this article
Liu, X., Min, S., Zhang, H. et al. Anterior corpectomy versus posterior laminoplasty for multilevel cervical myelopathy: a systematic review and meta-analysis. Eur Spine J 23, 362–372 (2014). https://doi.org/10.1007/s00586-013-3043-7
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-013-3043-7