Systematic Review of Cohort Studies Comparing Surgical Treatments for Cervical Spondylotic Myelopathy

In Brief Study Design. Systematic review of cohort studies comparing surgical treatment options for cervical spondylotic myelopathy. Objective. Compare results of major surgical treatments. Summary of Background Data. Controversy exists between various surgical options for the treatment of multilevel cervical spondylotic myelopathy, including multilevel corpectomy (CORP) and fusion, anterior cervical discectomy and fusion, laminoplasty (LAMP), and laminectomy and fusion (LAMI). A systematic review was done in order to compare results and complications among these procedures. Methods. Systematic review of retrospective cohort studies comparing anterior cervical discectomy and fusion (ACDF), CORP, LAMP, and LAMI from 1980 to January 2008. Separately, a review was performed of case series with greater than 10-year follow-up. Results. About 1735 articles found initially, 591 abstracts screened, 36 articles retrieved in full, 11 studies included in review. All comparison studies are retrospective cohort studies. Four studies compared multilevel CORP versus LAMP, 1 study compared LAMI with LAMP, and 2 studies compared ACDF with LAMP. There were 3 case studies with greater than 10-year follow-up. Conclusion. All approaches yield similar neuro recovery rates. Laminoplasty has a significant incidence of neck pain compared with multilevel CORP. ACDFs increase the rate of adjacent secondary spondylosis compared with LAMP. Multilevel CORP and laminectomy with fusion have a significantly higher rate of graft, instrumentation, and approach related complications. Multilevel CORP and laminectomy with fusion have a significant decrease in range of motion of neck compared with LAMP. There is no consensus on the best surgical approach for cervical spondylotic myelopathy. This systematic review looks at anterior cervical discectomy and fusion, laminectomy and fusion, multilevel corpectomy, and laminoplasty. Laminoplasty has fewer complications, possibly a greater range of motion and similar rates of neurologic recovery, but a greater incidence of neck pain.