24. Evaluating the efficacy of laminoplasty combined with anterior cervical discectomy and fusion (LP-A) versus ACDF alone in optimizing neurological recovery in severe multilevel cervical spondylotic myelopathy with a narrow cervical canal

Abstract

BACKGROUND CONTEXT

Cervical spinal stenosis with accompanying cervical myelopathy represents a significant clinical challenge, often resulting from a combination of congenital narrowing and degenerative changes such as disc protrusion, ligament hypertrophy, and kyphosis. These factors frequently lead to long-segment spinal cord compression. While multi-level anterior cervical discectomy and fusion (ACDF) remains a standard treatment for alleviating anterior compression and restoring cervical lordosis, its effectiveness is often limited in patients with severe compression or spinal cord signal changes observed on MRI. Additionally, the inability of ACDF to address posterior compressive forces in cases with a narrow spinal canal may contribute to persistent symptoms, suboptimal neurological recovery, and impaired quality of life postoperatively.

PURPOSE

To address these limitations, combining laminoplasty with ACDF (LP-A) has been proposed as a dual approach to decompress both anterior and posterior aspects of the spinal cord in patients with multilevel cervical spondylotic myelopathy (CSM) and a narrow spinal canal. This study aims to evaluate the clinical outcomes of LP-A compared to ACDF alone, focusing on neurological recovery and complication rates. By identifying patient and surgical factors associated with poor outcomes in ACDF, we seek to establish clearer guidelines for the optimal use of LP-A, ultimately improving care for patients with multilevel severe cervical spinal stenosis and myelopathy.

STUDY DESIGN/SETTING

Single-center retrospective cohort study.

PATIENT SAMPLE

A total of 72 patients (26 in LP-A group; 56 in ACDF group) with a 12-month follow-up were included.

OUTCOME MEASURES

Clinical outcomes: mJOA, VAS, NDI, myelopathy recovery rate; Radiographic outcomes: cervical lordosis, segmental lordosis, changes in lordosis and segmental lordosis, C2–7 SVA.

METHODS

Data were retrospectively reviewed from adults with CSM involving more than two-disc levels and a narrow cervical canal (< 14 mm) who underwent surgery between January 2017 and June 2023. Two surgical approaches were compared: LP-A method and ACDF alone. We collected quantitative and qualitative parameters of spinal cord compression on T2WI-MRI and used statistical analysis to identify factors related to unfavorable outcomes in the ACDF group. These factors were then used to screen both the LP-A and ACDF groups, and patients meeting the criteria for poor prognosis were further analyzed.

RESULTS

Multivariable logistic regression and ROC curve analysis identified that a compression ratio =34% and positive ISI on MRI are risk factors for a recovery rate < 75% in the ACDF group. Patients meeting these criteria were selected for comparison. The LP-A group showed significantly better outcomes than the ACDF group in terms of mJOA improvement (4.2±1.8 vs. 2.6±1.7, p=0.002) and recovery rate (74.9±17.6% vs. 58.7±34.3%, p=0.03). VAS and NDI scores improved postoperatively in both groups, with no significant differences between them. Radiographic parameters showed no significant changes within or between groups.

CONCLUSIONS

The LP-A strategy significantly improves neurological outcomes in high-risk (compression ratio =34% and positive ISI) cervical myelopathy patients with a narrow cervical canal compared to ACDF alone.

FDA Device/Drug Status

This abstract does not discuss or include any applicable devices or drugs.