General Session: Cervical Degenerative
Presented by: J.Y.W. Tan - View Audio/Video Presentation (Members Only)
J.Y.W. Tan(1), G. Liu(2), J.H. Ng(1), J.H. Tan(2), H.K. Wong(2)
(1) National University of Singapore, Singapore, Singapore
(2) National University Hospital, Singapore, Singapore, Singapore
Introduction: Posterior cervical approach is the treatment of choice for spinal cord compression related pathology in more than three segments. Previous studies have compared results of laminoplasty with laminectomy. However recent development of hybrid laminoplasty muscle sparing techniques are now evoked. To the best of the authors knowledge, no study validated the benefits of hybrid laminoplasty over laminectomy. This study aims to compare the clinical outcome of hybrid laminoplasty versus laminectomy with fusion. Methodology: A retrospectively matched cohort comparison between patients who underwent laminectomy with fusion and hybrid laminoplasty. Clinical, surgical, radiological data were captured. Statistical analyses were performed using SPSS software 184.108.40.206 (IBM Corporation).
Results: 42 patients with cervical cord compression in more than three segments were recruited with an average follow up duration of 20 months. 22 patients had laminectomy with fusion (LF) and 20 had hybrid laminoplasty (HP). There were no statistical difference between the 2 cohort in terms of age (60.4 ± 12.6 in LF vs. 62.2 ±6.5 in HP, p=0.56), sex (18 males and 4 females in LF vs. 15 males and 5 females in HP, p=0.59), trauma (11 non-trauma and 11 trauma patients in LF vs. 14 non-trauma patients and 6 non-trauma patients in HP, p = 0.19) and ASIA score (p=0.256). There was statistically significant less operative time in HP cohort (274 ± 80 minutes in LF vs. 208 minutes ± 42 in HP, p=0.003). Although there was a trend towards more blood loss in LF cohort (median blood loss = 300ml (100-1500)) compared to HP cohort (median blood loss = 150ml (25ml-1500)), this was not statistically significant (p=0.075).
A statistical significant improvement in Japanese orthopaedic association (JOA) scores and Nurick grade postoperatively was noted in both cohorts. Mean JOA score improved from 8.71 to 10.76 in LF group (p=0.005) and from 10.65 to 12.60 in HP group (p=0.001). The change in JOA scores between the two groups was not statistically significant (p = 0.661). Mean Nurick grade improved from 4.1 to 3.2 in LF group (p=0.007) and from 2.8 to 2.1 in HP group (p=0.016). The change in Nurick grade between the two groups was not statistically significant (p = 0.768). There was no statistical improvement in postoperative scores between the two cohorts in visual analog scale (p=0.409), EuroQol-5D (p=0.288), Neck Disability Index (p=0.351).
Operative complications was 18% in LF and 10% in HP group (p=0.252). Complications in LF group include 2 C5 palsy, 1 new onset numbness and 1 wound infection. In HP group, 1 patient had pneumonia, and 1 had septic shock secondary to bacteremia. No patients in HP group developed neurological complications; while this was not statistically significant (p=0.489), it was clinically significant. C5 palsy resolved after 9 months in both patients.
Conclusion: To the best of the author´s knowledge, this is the first report to confirm the benefits of hybrid laminoplasty over laminectomy with fusion. We demonstrated that hybrid laminoplasty has good clinical outcomes and has the potential to lower complication rates related to laminectomy with fusion.