Laminoplasty versus laminectomy for treatment of cervical spondylotic myelopathy: A randomized controlled Trial

Background

Cervical spondylotic myelopathy (CSM) is a prevalent cause of spinal cord dysfunction in older adults, often requiring surgical intervention for relief of spinal cord compression. This study aimed to compare the outcomes of two common surgical techniques, laminoplasty and laminectomy, in the treatment of multilevel CSM.

Methods

In a prospective cohort study, 30 patients with symptomatic multilevel CSM were randomly assigned to undergo either laminectomy or laminoplasty. Preoperative and postoperative evaluations included clinical assessments using the Visual Analog Scale (VAS), Nurick grade, Neck Disability Index (NDI), Japanese Orthopaedic Association (JOA) score, as well as radiological evaluations (MRI, X-ray). Surgical outcomes, complications, and long-term recovery were also assessed.

Results

Both groups showed significant postoperative improvements in clinical measures, including VAS, Nurick, and NDI scores. However, the laminoplasty group demonstrated greater improvements in NDI scores (p < 0.001) and lower postoperative VAS scores (p = 0.003). Radiologically, laminectomy provided greater decompression, as evidenced by a larger increase in the dural sac cross-sectional area (p < 0.001). Both groups exhibited similar complication rates, but the laminectomy group had a higher incidence of C5 radiculopathy and axial neck pain (p = 0.003 for both).

Conclusion

Overall, both procedures demonstrated significant clinical benefits, and the choice of technique should be tailored to individual patient needs based on factors such as cervical alignment and risk of complications. Further studies with larger cohorts are needed to refine surgical decision-making in CSM treatment.