Laminoplasty—an underutilized procedure for cervical spondylotic myelopathy

Wylie Y. Lopez; Brian C. Goh; Shivam Upadhyaya; Chason Ziino; Peter J. Georgakas; Anmol Gupta; Daniel G. Tobert; Harold A. Fogel; Thomas D. Cha; Joseph H. Schwab; Christopher M. Bono; Stuart H. Hershman

doi:10.1016/j.spinee.2020.10.021

Laminoplasty—an underutilized procedure for cervical spondylotic myelopathy

Wylie Y. Lopez, Brian C. Goh, Shivam Upadhyaya, Chason Ziino, Peter J. Georgakas, Anmol Gupta, Daniel G. Tobert, Harold A. Fogel, Thomas D. Cha, Joseph H. Schwab, Christopher M. Bono, Stuart H. Hershman

Icahn School of Medicine at Mount Sinai

Research output: Contribution to journal › Article › peer-review

19 Scopus citations

Abstract

BACKGROUND CONTENT: Cervical laminoplasty (LP) and laminectomy and fusion (LF) are commonly used surgical techniques for cervical spondylotic myelopathy (CSM). Several recent studies have demonstrated superior perioperative metrics and decreased overall costs with LP, yet LF is performed far more often in the United States. PURPOSE: To determine the percentage of patients with CSM who are radiographically candidates for LP. STUDY DESIGN: Retrospective comparative cohort study. PATIENT SAMPLE: Patients >18 years old who underwent LF or LP for CSM at 2 large academic institutions from 2017 to 2019. OUTCOME MEASURES: Candidacy for LP based on radiographic criteria. METHODS: Radiographs were assessed by 2 spine surgeons not involved in the care of the patients to determine the C2–C7 Cobb angle and the presence and extent of cervical instability. Patients with kyphosis >13°, > 3.5 mm of listhesis on static imaging, or > 2.5 mm of motion on flexion-extension or standing-supine films were not considered candidates for LP. Intraclass coefficient (ICC) was calculated to assess the interobserver reliability of angular measurements and the presence of instability. The percentage of patients for whom LP was contraindicated was calculated. RESULTS: One hundred eight patients underwent LF while 142 underwent LP. Of the 108 patients who underwent LF, 79.6% were radiographically deemed candidates for LP, as were all 142 patients who underwent LP. The ICC for C2–C7 alignment was 0.90; there was 97% agreement with respect to the presence of instability. CONCLUSIONS: In 250 patients with CSM, 228 (91.2%) were radiographically candidates for LP. These data suggest that LP may be an underutilized procedure for the treatment for CSM.

Original language	English
Pages (from-to)	571-577
Number of pages	7
Journal	Spine Journal
Volume	21
Issue number	4
DOIs	https://doi.org/10.1016/j.spinee.2020.10.021
State	Published - Apr 2021

Keywords

Cervical laminoplasty
Cervical spondylotic myelopathy
Cervical stenosis
Laminoplasty
Myelopathy
Posterior cervical laminectomy and fusion

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10.1016/j.spinee.2020.10.021

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@article{0910b6baa0c94085af2efa58bdb1ee7e,

title = "Laminoplasty—an underutilized procedure for cervical spondylotic myelopathy",

abstract = "BACKGROUND CONTENT: Cervical laminoplasty (LP) and laminectomy and fusion (LF) are commonly used surgical techniques for cervical spondylotic myelopathy (CSM). Several recent studies have demonstrated superior perioperative metrics and decreased overall costs with LP, yet LF is performed far more often in the United States. PURPOSE: To determine the percentage of patients with CSM who are radiographically candidates for LP. STUDY DESIGN: Retrospective comparative cohort study. PATIENT SAMPLE: Patients >18 years old who underwent LF or LP for CSM at 2 large academic institutions from 2017 to 2019. OUTCOME MEASURES: Candidacy for LP based on radiographic criteria. METHODS: Radiographs were assessed by 2 spine surgeons not involved in the care of the patients to determine the C2–C7 Cobb angle and the presence and extent of cervical instability. Patients with kyphosis >13°, > 3.5 mm of listhesis on static imaging, or > 2.5 mm of motion on flexion-extension or standing-supine films were not considered candidates for LP. Intraclass coefficient (ICC) was calculated to assess the interobserver reliability of angular measurements and the presence of instability. The percentage of patients for whom LP was contraindicated was calculated. RESULTS: One hundred eight patients underwent LF while 142 underwent LP. Of the 108 patients who underwent LF, 79.6% were radiographically deemed candidates for LP, as were all 142 patients who underwent LP. The ICC for C2–C7 alignment was 0.90; there was 97% agreement with respect to the presence of instability. CONCLUSIONS: In 250 patients with CSM, 228 (91.2%) were radiographically candidates for LP. These data suggest that LP may be an underutilized procedure for the treatment for CSM.",

keywords = "Cervical laminoplasty, Cervical spondylotic myelopathy, Cervical stenosis, Laminoplasty, Myelopathy, Posterior cervical laminectomy and fusion",

author = "Lopez, {Wylie Y.} and Goh, {Brian C.} and Shivam Upadhyaya and Chason Ziino and Georgakas, {Peter J.} and Anmol Gupta and Tobert, {Daniel G.} and Fogel, {Harold A.} and Cha, {Thomas D.} and Schwab, {Joseph H.} and Bono, {Christopher M.} and Hershman, {Stuart H.}",

note = "Publisher Copyright: {\textcopyright} 2020 Elsevier Inc.",

year = "2021",

month = apr,

doi = "10.1016/j.spinee.2020.10.021",

language = "English",

volume = "21",

pages = "571--577",

journal = "Spine Journal",

issn = "1529-9430",

publisher = "Elsevier Inc.",

number = "4",

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TY - JOUR

T1 - Laminoplasty—an underutilized procedure for cervical spondylotic myelopathy

AU - Lopez, Wylie Y.

AU - Goh, Brian C.

AU - Upadhyaya, Shivam

AU - Ziino, Chason

AU - Georgakas, Peter J.

AU - Gupta, Anmol

AU - Tobert, Daniel G.

AU - Fogel, Harold A.

AU - Cha, Thomas D.

AU - Schwab, Joseph H.

AU - Bono, Christopher M.

AU - Hershman, Stuart H.

PY - 2021/4

Y1 - 2021/4

N2 - BACKGROUND CONTENT: Cervical laminoplasty (LP) and laminectomy and fusion (LF) are commonly used surgical techniques for cervical spondylotic myelopathy (CSM). Several recent studies have demonstrated superior perioperative metrics and decreased overall costs with LP, yet LF is performed far more often in the United States. PURPOSE: To determine the percentage of patients with CSM who are radiographically candidates for LP. STUDY DESIGN: Retrospective comparative cohort study. PATIENT SAMPLE: Patients >18 years old who underwent LF or LP for CSM at 2 large academic institutions from 2017 to 2019. OUTCOME MEASURES: Candidacy for LP based on radiographic criteria. METHODS: Radiographs were assessed by 2 spine surgeons not involved in the care of the patients to determine the C2–C7 Cobb angle and the presence and extent of cervical instability. Patients with kyphosis >13°, > 3.5 mm of listhesis on static imaging, or > 2.5 mm of motion on flexion-extension or standing-supine films were not considered candidates for LP. Intraclass coefficient (ICC) was calculated to assess the interobserver reliability of angular measurements and the presence of instability. The percentage of patients for whom LP was contraindicated was calculated. RESULTS: One hundred eight patients underwent LF while 142 underwent LP. Of the 108 patients who underwent LF, 79.6% were radiographically deemed candidates for LP, as were all 142 patients who underwent LP. The ICC for C2–C7 alignment was 0.90; there was 97% agreement with respect to the presence of instability. CONCLUSIONS: In 250 patients with CSM, 228 (91.2%) were radiographically candidates for LP. These data suggest that LP may be an underutilized procedure for the treatment for CSM.

AB - BACKGROUND CONTENT: Cervical laminoplasty (LP) and laminectomy and fusion (LF) are commonly used surgical techniques for cervical spondylotic myelopathy (CSM). Several recent studies have demonstrated superior perioperative metrics and decreased overall costs with LP, yet LF is performed far more often in the United States. PURPOSE: To determine the percentage of patients with CSM who are radiographically candidates for LP. STUDY DESIGN: Retrospective comparative cohort study. PATIENT SAMPLE: Patients >18 years old who underwent LF or LP for CSM at 2 large academic institutions from 2017 to 2019. OUTCOME MEASURES: Candidacy for LP based on radiographic criteria. METHODS: Radiographs were assessed by 2 spine surgeons not involved in the care of the patients to determine the C2–C7 Cobb angle and the presence and extent of cervical instability. Patients with kyphosis >13°, > 3.5 mm of listhesis on static imaging, or > 2.5 mm of motion on flexion-extension or standing-supine films were not considered candidates for LP. Intraclass coefficient (ICC) was calculated to assess the interobserver reliability of angular measurements and the presence of instability. The percentage of patients for whom LP was contraindicated was calculated. RESULTS: One hundred eight patients underwent LF while 142 underwent LP. Of the 108 patients who underwent LF, 79.6% were radiographically deemed candidates for LP, as were all 142 patients who underwent LP. The ICC for C2–C7 alignment was 0.90; there was 97% agreement with respect to the presence of instability. CONCLUSIONS: In 250 patients with CSM, 228 (91.2%) were radiographically candidates for LP. These data suggest that LP may be an underutilized procedure for the treatment for CSM.

KW - Cervical laminoplasty

KW - Cervical spondylotic myelopathy

KW - Cervical stenosis

KW - Laminoplasty

KW - Myelopathy

KW - Posterior cervical laminectomy and fusion

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DO - 10.1016/j.spinee.2020.10.021

M3 - Article

C2 - 33152508

AN - SCOPUS:85096394163

SN - 1529-9430

VL - 21

SP - 571

EP - 577

JO - Spine Journal

JF - Spine Journal

IS - 4

ER -

Laminoplasty—an underutilized procedure for cervical spondylotic myelopathy

Abstract

Keywords

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