Skip laminectomy versus cervical laminectomy, an analysis of patient reported outcomes, spinal alignment and re-operation rates: The Leeds spinal unit experience (2008–2016)

摘要

The two leading techniques in the UK utilised in the posterior decompression of the cervical spinal cord for cervical spondylotic myelopathy (CSM) are skip laminectomy (Skip LAMT) and open cervical laminectomy (LAMT). To the authors' knowledge no studies have directly compared effectiveness of skip laminectomy versus cervical laminectomy. This study assessed for differences in neck disability index, sagittal alignment and re-operation rates between both treatment options. A retrospective single institution cohort study was performed. Subjects underwent skip- or cervical laminectomy between 2008 and 2016. Patients whom had undergone previous cervical spinal surgery were excluded. Statistical analysis compared radiological differences in sagittal alignment of the vertebral bodies between C2-7 pre- and post-operatively in static lateral cervical spine radiographs using the Cobb method. A description of the surgical technique of skip laminectomy is also provided. In total 42 patients and 29 patients had skip and cervical laminectomy respectively. Both groups were matched pre-operatively in terms of cervical sagittal alignment (p?=?0.17), age and gender. Median follow up time was 32?±?23.1 (Range: 1–325) weeks. Post-operatively there was no difference in patient reported outcomes namely Visual Analogue Scale and Neck Disability Index between treatment groups compared to pre-operatively (p?=?0.64 andp?=?0.75). There was suggestion of difference in median length of hospital stay between treatment groups, however this was not statistically significant. There was no difference in sagittal alignment between groups following surgery (p?=?0.65). Three patients (7.1%) in the skip laminectomy group and two patients (6.9%) in the cervical laminectomy group required revision surgery. No patients needed instrumentation. Skip laminectomy and cervical laminectomy deliver similar patient reported outcomes, sagittal alignment preservation and re-operation rates over this follow-up period.