Cervical laminectomy vs laminoplasty: is there a difference in outcome and postoperative pain?

Background: Cervical laminoplasty is often used for the decompression of multilevel cervical spondylotic myelopathy without creating spinal instability and kyphosis.

Objective: To assess the axial pain, quality of life, sagittal alignment, and extent of decompression after standard cervical laminectomy or laminoplasty. We further evaluate whether the sagittal alignment changes over time after both procedures and whether axial pain depends on sagittal alignment.

Methods: We reviewed 268 patients with cervical radiculopathy or myelopathy who had undergone standard cervical laminectomy or laminoplasty between January 1999 and January 2009. The clinical outcome was analyzed by visual analog scale for neck pain. The quality of life was analyzed by EQ-5D questionnaire. The degree of deformity and extent of decompression were assessed using the Ishihara index and Pavlov's ratio, respectively.

Results: Laminoplasty was associated with more neck pain and worse quality of life when 4 or more levels were decompressed compared with the laminectomy group. For operations of 3 or fewer levels, there was no difference. Interestingly, the radiological effectiveness of decompression was greater in the laminoplasty group.

Conclusion: Laminoplasty for 4 or more cervical levels was associated with more axial pain and consequently poorer quality of life than laminectomy. There was a similar loss of sagittal alignment in both the laminectomy and laminoplasty groups over time. Our results suggest there is no clear benefit of laminoplasty over laminectomy in patients who do not have spinal instability.