Comparison Of Effectivity And Safety Between Laminoplasty And Laminectomy With Fusion For Multi-level Cervical Spondylotic Myelopathy:A Meta-analysis

Background:Posterior surgical approaches,including laminoplasty(LP)and laminectomy with fusion(LF),are commonly used for treatment of multi-level cervical spondylotic myelopathy(CSM).Both of LF and LP can perform the decompression by removing or moving backward the structures of the involved spinal canal which may cause the spinal stenosis.However,because of the different procedures,the complications and their rates are various.Until now,the comparison of effectivity and safety between the two approaches are still not well established,so it remains unclear that which approach is the better option for treatment of multi-level CSM.Objective:Using the method of Meta-analysis,systematically evaluate the effectivity and safety between LP and LF for multi-level CSM.Methods:Using the Pubmed,the Cochrane Library and the Embase databases,electronic searches all of the clinical studies about the comparison of LF and LP for multi-level CSM are performed from their dates to June 2017.Identify all relevant randomized controlled trails(RCTs)and non-RCTs according to the selection criteria,then perform the assessment of evidence quality and the data extraction.All data were analyzed by Revman Software(Version 5.3).Result:13 studies,including 11 retrospective cohort studies and 2 prospective cohort studies,were included in this Meta-analysis.Overall,there were 583 patients who underwent LF with 579 patients underwent LP.Compared to the LF group,the total complication rate of LP group [RR=1.74,95%CI(1.37,2.20),P<0.01] as well as the C5 nerve root palsy rate [RR=2.16,95%CI(1.15,4.03),P=0.02] was lower.Also,the mean operation time of LP group was shorter than that of LF groups [SMD=1.04,95%CI(0.85,1.24)P<0.01],and the mean intraoperative blood loss of LP groups was less than that of LF groups [SMD=0.68,95%CI(0.46,0.91),P<0.01].Others,there was no statistical difference found between LF and LP groups in terms of preoperative Japanese Orthopaedic Association(JOA)scale [SMD=0.14,95%CI(-0.02,0.30),P=0.09],postoperative JOA scale [SMD=0.18,95%CI(-0.04,0.39),P=0.10],preoperative Visual Analogue Scale(VAS)[SMD=0.15,95%CI(-0.04,0.34),P=0.12],postoperative VAS [SMD=0.03,95%CI(-0.16,0.22),P=0.79],postoperative cervical curvature index(CCI)[SMD=-0.00,95%CI(-0.24,0.24),P=0.97] and reoperation rate [RR=1.09,95%CI(0.47,2.52),P=0.85].Conclusion:From the present evidence,LF and LP approaches for CSM shares the similar clinical improvement.However,a lower total complication rate,especially the C5 nerve root palsy rate,was found in LP groups,which result in a short advantage of LP.But the long-term effectivity and safety of the two approaches still need further evaluation.