Clinical comparison between simple laminectomy and laminectomy plus posterior instrumentation in surgical treatment of cervical myelopathy

  • G. Gargiulo
  • M. Girardo
  • A. Rava
  • A. Coniglio
  • P. Cinnella
  • A. Massè
  • F. FusiniEmail author
Original Article • SPINE - CERVICAL



Posterior stabilization in patients treated with laminectomy for spondylotic cervical myelopathy is still a debate. Despite both being reported in literature by several authors, some controversies still exist. The aim of this study is to compare clinical and radiological outcomes in patients treated with laminectomy or laminectomy with posterior stabilization.

Material and methods

We retrospectively evaluated 42 patients affected by cervical myelopathy (mean age 70.43 ± 5.03 years), 19 treated with laminectomy (group A) and 23 with laminectomy and posterior instrumentation (group B). Neurological status was assessed with Nurick scale, pain with VAS and radiological parameters with C2–C7 SVA, T1 slope and C2–C7 lordosis, clinical function with modified Japanese Orthopaedic Association score (JOA). Also, surgery time and blood loss were recorded. Student’s t test was used for continuous variables, while Kruskal–Wallis test was used for categorical values.


No differences were found in postoperative Nurick scale (p = 0.587), VAS (p = 0.62), mJOA (p = 0.197) and T1 slope (p = 0.559), while laminectomy with fusion showed better postoperative cervical lordosis (p = 0.007) and C2–C7 SVA (p < 0.00001), but higher blood loss (p < 0.00001) and surgical time (p < 0.00001). Both groups showed better Nurick scale (p = 0.00017 for group A and p = 0.00081 for group B), VAS (p = 0.02 for group A and p = 0.046 for group B) and mJOA (p < 0.00001 for both groups) than preoperative values.


Both treatments are a valuable choice, offering some benefits and disadvantages against each other. Each procedure must be carefully evaluated on the basis of patients’ general status, preoperative pain, signs of instability and potential benefits from cervical alignment correction.


Spondylotic cervical myelopathy Elderly Laminectomy Posterior fusion Lateral mass screw 


Compliance with ethical standards

Conflict of interest

All authors declare they have no conflict of interest.


  1. 1.
    Boogaarts HD, Bartels RHMA (2015) Prevalence of cervical spondylotic myelopathy. Eur Spine J 24(Suppl 2):139–141. CrossRefGoogle Scholar
  2. 2.
    Choi B-W, Kim S-S, Lee D-H, Kim J-W (2017) Cervical radiculopathy combined with cervical myelopathy: prevalence and characteristics. Eur J Orthop Surg Traumatol 27:889–893. CrossRefGoogle Scholar
  3. 3.
    Wu J-C, Chen Y-C, Huang W-C (2018) Ossification of the posterior longitudinal ligament in cervical spine: prevalence, management, and prognosis. Neurospine 15:33–41. CrossRefGoogle Scholar
  4. 4.
    Ellingson BM, Salamon N, Hardy AJ, Holly LT (2015) Prediction of neurological impairment in cervical spondylotic myelopathy using a combination of diffusion MRI and proton MR spectroscopy. PLoS ONE 10:e0139451. CrossRefGoogle Scholar
  5. 5.
    Singrakhia MD, Malewar NR, Singrakhia SM, Deshmukh SS (2017) Cervical laminectomy with lateral mass screw fixation in cervical spondylotic myelopathy: neurological and sagittal alignment outcome: do we need lateral mass screws at each segment? Indian J Orthop 51:658–665. CrossRefGoogle Scholar
  6. 6.
    Miyazaki K, Tada K, Matsuda Y et al (1989) Posterior extensive simultaneous multisegment decompression with posterolateral fusion for cervical myelopathy with cervical instability and kyphotic and/or S-shaped deformities. Spine (Phila Pa 1976) 14:1160–1170CrossRefGoogle Scholar
  7. 7.
    Mayer M, Meier O, Auffarth A, Koller H (2015) Cervical laminectomy and instrumented lateral mass fusion: techniques, pearls and pitfalls. Eur Spine J 24(Suppl 2):168–185. CrossRefGoogle Scholar
  8. 8.
    Kurokawa R, Kim P (2015) Cervical laminoplasty: the history and the future. Neurol Med Chir (Tokyo) 55:529–539. CrossRefGoogle Scholar
  9. 9.
    Gelalis ID, Papadopoulos DV, Giannoulis DK et al (2018) Spinal motion preservation surgery: indications and applications. Eur J Orthop Surg Traumatol 28:335–342. CrossRefGoogle Scholar
  10. 10.
    Della Pepa GM, Roselli R, La Rocca G et al (2014) Laminoplasty is better of laminectomy in cervical stenotic myelopathy: myth or truth? Eur Rev Med Pharmacol Sci 18:50–54Google Scholar
  11. 11.
    Kode S, Kallemeyn NA, Smucker JD et al (2014) The effect of multi-level laminoplasty and laminectomy on the biomechanics of the cervical spine: a finite element study. Iowa Orthop J 34:150–157Google Scholar
  12. 12.
    Rhee JM, Basra S (2008) Posterior surgery for cervical myelopathy: laminectomy, laminectomy with fusion, and laminoplasty. Asian Spine J 2:114. CrossRefGoogle Scholar
  13. 13.
    Alizada M, Li RR, Hayatullah G (2018) Cervical instability in cervical spondylosis patients. Orthopade 47:977–984. CrossRefGoogle Scholar
  14. 14.
    Association JO (1994) Scoring system for cervical myelopathy. Nippon Seikeigeka Gakkai Zasshi 68:490–503Google Scholar
  15. 15.
    Nurick S (1972) The pathogenesis of the spinal cord disorder associated with cervical spondylosis. Brain 95:87–100CrossRefGoogle Scholar
  16. 16.
    Guigui P, Benoist M, Deburge A (1998) Spinal deformity and instability after multilevel cervical laminectomy for spondylotic myelopathy. Spine (Phila Pa 1976) 23:440–447CrossRefGoogle Scholar
  17. 17.
    Kaptain GJ, Simmons NE, Replogle RE, Pobereskin L (2000) Incidence and outcome of kyphotic deformity following laminectomy for cervical spondylotic myelopathy. J Neurosurg 93:199–204CrossRefGoogle Scholar
  18. 18.
    Pal GP, Sherk HH (1988) The vertical stability of the cervical spine. Spine (Phila Pa 1976) 13:447–449CrossRefGoogle Scholar
  19. 19.
    Cho W-S, Chung CK, Jahng T-A, Kim HJ (2008) Post-laminectomy kyphosis in patients with cervical ossification of the posterior longitudinal ligament: does it cause neurological deterioration? J Korean Neurosurg Soc 43:259–264. CrossRefGoogle Scholar
  20. 20.
    Passias PG, Oh C, Horn SR et al (2018) Predicting the occurrence of complications following corrective cervical deformity surgery: analysis of a prospective multicenter database using predictive analytics. J Clin Neurosci 59:155–161. CrossRefGoogle Scholar
  21. 21.
    Protopsaltis T, Terran J, Soroceanu A et al (2018) T1 slope minus cervical lordosis (TS-CL), the cervical answer to PI-LL, defines cervical sagittal deformity in patients undergoing thoracolumbar osteotomy. Int J Spine Surg 12:362–370. CrossRefGoogle Scholar
  22. 22.
    Scheer JK, Ames CP, Deviren V (2013) Assessment and treatment of cervical deformity. Neurosurg Clin N Am 24:249–274. CrossRefGoogle Scholar
  23. 23.
    Yoon ST, Hashimoto RE, Raich A et al (2013) Outcomes after laminoplasty compared with laminectomy and fusion in patients with cervical myelopathy. Spine (Phila Pa 1976) 38:S183–S194. CrossRefGoogle Scholar
  24. 24.
    Lau D, Winkler EA, Than KD et al (2017) Laminoplasty versus laminectomy with posterior spinal fusion for multilevel cervical spondylotic myelopathy: influence of cervical alignment on outcomes. J Neurosurg Spine 27:508–517. CrossRefGoogle Scholar
  25. 25.
    Ratliff JK, Cooper PR (2003) Cervical laminoplasty: a critical review. J Neurosurg 98:230–238Google Scholar
  26. 26.
    Denaro V, Di Martino A (2011) Cervical spine surgery: an historical perspective. Clin Orthop Relat Res 469:639–648. CrossRefGoogle Scholar
  27. 27.
    Karadimas SK, Erwin WM, Ely CG et al (2013) Pathophysiology and natural history of cervical spondylotic myelopathy. Spine (Phila Pa 1976) 38:S21–S36. CrossRefGoogle Scholar
  28. 28.
    Yamazaki T, Yanaka K, Sato H et al (2003) Cervical spondylotic myelopathy: surgical results and factors affecting outcome with special reference to age differences. Neurosurgery 52:122–126 (discussion 126) Google Scholar
  29. 29.
    Sudo H, Ito M, Abumi K et al (2006) Long-term follow up of surgical outcomes in patients with cervical disorders undergoing hemodialysis. J Neurosurg Spine 5:313–319. CrossRefGoogle Scholar
  30. 30.
    Kumar A, Leventhal MR, Freedman EL et al (1997) Destructive spondyloarthropathy of the cervical spine in patients with chronic renal failure. Spine (Phila Pa 1976) 22:573–577 (discussion 578) CrossRefGoogle Scholar
  31. 31.
    Elder BD, Petteys RJ, Sciubba DM, Wolinsky J-P (2016) Challenges of cervical reconstruction for destructive spondyloarthropathy in renal osteodystrophy. J Clin Neurosci 30:155–157. CrossRefGoogle Scholar
  32. 32.
    Maruo K, Moriyama T, Tachibana T et al (2017) Prognosis and adjacent segment disease after lumbar spinal fusion surgery for destructive spondyloarthropathy in long-term hemodialysis patients. J Orthop Sci 22:248–253. CrossRefGoogle Scholar
  33. 33.
    Farrokhi MR, Ghaffarpasand F, Khani M, Gholami M (2016) An evidence-based stepwise surgical approach to cervical spondylotic myelopathy: a narrative review of the current literature. World Neurosurg 94:97–110. CrossRefGoogle Scholar
  34. 34.
    Tsai T-T, Kaliya-Perumal A-K, Jenq C-C et al (2017) The unresolved problem of beta-2 microglobulin amyloid deposits in the intervertebral discs of long-term dialysis patients. J Orthop Surg Res 12:194. CrossRefGoogle Scholar
  35. 35.
    Veeravagu A, Ponnusamy K, Jiang B et al (2012) Renal osteodystrophy: neurosurgical considerations and challenges. World Neurosurg 78:191.e23–191.e33. CrossRefGoogle Scholar
  36. 36.
    Law MD, Bernhardt M, White AA et al (1993) Cervical spondylotic myelopathy: a review of surgical indications and decision making. Yale J Biol Med 66:165–177Google Scholar
  37. 37.
    Hasegawa K, Hirano T, Shimoda H, Homma T, Morita O (2008) Indications for cervical pedicle screw instrumentation in nontraumatic lesions. Spine (Phila Pa 1976) 33:2284–2289. CrossRefGoogle Scholar
  38. 38.
    Abumi K (2015) Cervical spondylotic myelopathy: posterior decompression and pedicle screw fixation. Eur Spine J 24:186–196. CrossRefGoogle Scholar
  39. 39.
    Park MS, Ju Y-S, Moon S-H et al (2016) Reoperation rates after surgery for degenerative cervical spine disease according to different surgical procedures: national population-based cohort study. Spine (Phila Pa 1976) 41:1484–1492. CrossRefGoogle Scholar
  40. 40.
    Girardo M, Rava A, Fusini F et al (2018) Different pedicle osteosynthesis for thoracolumbar vertebral fractures in elderly patients. Eur Spine J. Google Scholar
  41. 41.
    Girardo M, Cinnella P, Gargiulo G et al (2017) Surgical treatment of osteoporotic thoraco-lumbar compressive fractures: the use of pedicle screw with augmentation PMMA. Eur Spine J 26:546–551. CrossRefGoogle Scholar
  42. 42.
    Girardo RA, Gargiulo G et al (2019) Clinical and radiological union rate evaluation of type 2 odontoid fractures: a comparison between anterior screw fixation and halo vest in elderly patients. J Craniovertebr Junction Spine 9:254. Google Scholar
  43. 43.
    Morishita Y, Matsushita A, Maeda T et al (2015) Rapid progressive clinical deterioration of cervical spondylotic myelopathy. Spinal Cord 53:408–412. CrossRefGoogle Scholar
  44. 44.
    Du W, Wang L, Shen Y et al (2013) Long-term impacts of different posterior operations on curvature, neurological recovery and axial symptoms for multilevel cervical degenerative myelopathy. Eur Spine J 22:1594–1602. CrossRefGoogle Scholar
  45. 45.
    Isogai N, Nagoshi N, Iwanami A et al (2018) Surgical treatment of cervical spondylotic myelopathy in the elderly. Spine (Phila Pa 1976). Google Scholar
  46. 46.
    Cecchinato R, Langella F, Bassani R et al (2014) Variations of cervical lordosis and head alignment after pedicle subtraction osteotomy surgery for sagittal imbalance. Eur Spine J 23(Suppl 6):644–649. CrossRefGoogle Scholar
  47. 47.
    Berjano P, Langella F, Ismael M-F et al (2014) Successful correction of sagittal imbalance can be calculated on the basis of pelvic incidence and age. Eur Spine J 23(Suppl 6):587–596. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Spine Surgery Unit, Orthopaedic and Trauma CentreAzienda Ospedaliera Città della Salute e della ScienzaTurinItaly
  2. 2.Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, Azienda Ospedaliera Città della Salute e della ScienzaUniversity of TurinTurinItaly

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