Cervical Myelopathy Treated by Laminoplasty vs ACDF

A common problem that we face in our practice treating cervical herniated discs is of those patients who present with cervical myelopathy. Myelopathy is compression of the spinal cord by disc or osteophytes (bony ridges).

Generally, there have been two well-accepted treatment modalities to approach this problem. One is ananterior cervical discectomy and subsequent fusion.  That is a procedure that will decompress the spinal cord from an anterior approach followed by fusion.

The second common operative procedure is what is called a posterior laminoplasty. With that procedure,   the spinal cord is decompressed by opening up the bone in the back of the spinal canal called the lamina.

It has been debatable as to which approach is preferable in patients with cervical myelopathy. It was then with some interest that Dr. Sang et al from the Singapore General Hospital reported on a prospective two-year study of patients treated either with multilevel anterior cervical decompression and fusion with plating or posterior laminoplasty. This was published in an excellent peer-reviewed journal called The Spine Journal in 2013. The results demonstrate that patients with multilevel cervical myelopathy when treated with laminoplasty do well and compared favorably with those patients treated with an anterior approach with a followup of two years.

They report the posterior laminoplasty surgery was associated with a shorter operating time, better range of motion, and the tendency towards fewer complications. They also conclude that a larger randomized study needs to be done to support these findings.

This study is important because so many surgeons and patients alike are faced with the option of one or another approach.

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