Comparative Effectiveness of Different Types of Cervical Laminoplasty

Study Design Systematic review. Study Rationale Numerous cervical laminoplasty techniques have been described but there are few studies that have compared these to determine the superiority of one over another. Clinical Questions The clinical questions include key question (KQ)1: In adults with cervical myelopathy from ossification of the posterior longitudinal ligament (OPLL) or spondylosis, what is the comparative effectiveness of open door cervical laminoplasty versus French door cervical laminoplasty? KQ2: In adults with cervical myelopathy from OPLL or spondylosis, are postoperative complications, including pain and infection, different for the use of miniplates versus the use of no plates following laminoplasty? KQ3: Do these results vary based on early active postoperative cervical motion? Materials and Methods A systematic review of the English-language literature was undertaken for articles published between 1970 and March 11, 2013. Electronic databases and reference lists of key articles were searched to identify studies evaluating (1) open door cervical laminoplasty and French door cervical laminoplasty and (2) the use of miniplates or no plates in cervical laminoplasty for the treatment of cervical spondylotic myelopathy or OPLL in adults. Studies involving traumatic onset, cervical fracture, infection, deformity, or neoplasms were excluded, as were noncomparative studies. Two independent reviewers (A.L.R., J.R.D.) assessed the level of evidence quality using the Grades of Recommendations Assessment, Development and Evaluation system, and disagreements were resolved by consensus. Results We identified three studies (one of class of evidence [CoE] II and two of CoE III) meeting our inclusion criteria comparing open door cervical laminoplasty with French door laminoplasty and two studies (one CoE II and one CoE III) comparing the use of miniplates with no plates. Data from one randomized controlled trial (RCT) and two retrospective cohort studies suggest no difference between treatment groups regarding improvement in myelopathy. One RCT reported significant improvement in axial pain and significantly higher short-form 36 scores in the French door laminoplasty treatment group. Overall, complications appear to be higher in the open door group than the French door group, although complete reporting of complications was poor in all studies. Overall, data from one RCT and one retrospective cohort study suggest that the incidence of complications (including reoperation, radiculopathy, and infection) is higher in the no plate treatment group compared with the miniplate group. One RCT reported greater pain as measured by the visual analog scale score in the no plate treatment group. There was no evidence available to assess the effect of early cervical motion for open door cervical laminoplasty compared with French door laminoplasty. Both studies comparing the use of miniplates and no plates reported early postoperative motion. Evidence from one RCT suggests that earlier postoperative cervical motion might reduce pain. Conclusion Data from three comparative studies are not sufficient to support the superiority of open door cervical laminoplasty or French door cervical laminoplasty. Data from two comparative studies are not sufficient to support the superiority of the use of miniplates or no plates following cervical laminoplasty. The overall strength of evidence to support any conclusions is low or insufficient. Thus, the debate continues while opportunity exists for the spine surgery community to resolve these issues with appropriately designed clinical studies.