169 Laminoplasty vs Laminectomy With Posterior Spinal Fusion for Multilevel Cervical Spondylotic Myelopathy: Matched Cohorts of Regional Sagittal Balance.

INTRODUCTION: Cervical curvature is an important factor when deciding between laminoplasty or laminectomy with posterior spinal fusion (PSF). This study compares outcomes of laminoplasty and laminectomy with PSF in patients with matched regional sagittal balance.

METHODS: Adults from 2011 to 2014 undergoing laminoplasty or laminectomy with PSF for cervical spondylotic myelopathy were identified. Matched cohorts were obtained by excluding laminectomy with PSF patients with postoperative cervical Cobb angles outside the range of laminoplasty patients. Perioperative and follow-up outcomes were compared. Subgroup analysis of patients with and without preoperative pain was performed.

RESULTS: A total of 145 patients were included in the analysis: 44 laminectomy with PSF and 101 laminoplasty patients were included. Preoperative Nurick scores were similar (2.1 vs 2.2) (P = .738). The laminectomy with PSF group had higher preoperative pain rate (77.1% vs 46.5%) (P = .002), higher visual analog scale (VAS) (6.8 vs 5.1) (P = .017), and less cervical lordosis (5.7 vs 10.1°) (P = .082). Laminectomy with PSF had higher blood loss (335.3 vs 198.8 mL) (P = .001), longer stay (4.2 vs 3.4 days) (P = .032), and higher complications (20.0% vs 7.9%) (P = .063). At follow-up, laminectomy with PSF had lower mean Nurick score (0.9 vs 1.6, P = .029). Among patients with preoperative pain, follow-up pain rates (40.7% vs 36.2%) (P = .805) and VAS (5.0 vs 6.4) (P = .226) were similar between laminoplasty and laminectomy with PSF patients. In patients without preoperative pain, there was no difference in pain rates (12.5% vs 16.7%) (P = .999) and VAS (7.0 vs 5.7) (P = n/a). Cervical Cobb was similar (7.0 vs 5.9°) (P = .663). Mean follow-up was 17.2 months.

CONCLUSION: Laminectomy with PSF is associated with greater perioperative morbidity but provides greater myelopathy resolution than laminoplasty. With similar postoperative cervical Cobb angles, pain outcomes are similar for both procedures. Cervical alignment should be considered as an important factor in pain outcomes following posterior decompression of cervical spondylotic myelopathy.