Rethinking Laminoplasty for Cervical Spondylotic Myelopathy
No (or few) differences sometimes makes a big difference
What’s the Claim?
A well-matched large-database study with good completeness of follow-up found that patients with multilevel cervical spondylotic myelopathy (average of 4 ± 1 levels treated) were better off with laminoplasty than posterior cervical fusion in terms of the percentage returning to baseline activities three months after surgery (47% versus 21%). Patients treated with laminoplasty fared better in terms of healthcare utilization metrics, such as discharge to home rather than to an extended-care facility, reflecting the smaller size of that operation.
Otherwise, there were no important between-group differences, and the authors looked hard for those differences — dozens of time point/endpoint combinations were checked — out to two years.
- It’s that absence of difference that makes this study interesting, since that should tend to nudge us toward the smaller operation — laminoplasty.
