Brown Nolan J, Lien Brian V, Shahrestani Shane, Choi Elliot H, Tran Katelynn, Gattas Sandra, Ransom Seth C, Tafreshi Ali R, Ransom Ryan Chase, Sahyouni Ronald, Chan Alvin, Oh Michael
School of Medicine, University of California, Irvine, Irvine, CA, USA.
Keck School of Medicine of USC, Los Angeles, CA, USA.
Neurospine. 2021 Mar;18(1):45-54. doi: 10.14245/ns.2040520.260. Epub 2021 Mar 31.
Cervical spondylotic myelopathy (CSM) is a degenerative disorder leading to progressive decline in spinal cord function. Cervical laminoplasty (CLP) and cervical laminectomy with fusion (CLF) are standard treatments for multilevel CSM. However, it is still unclear whether one procedure over the other provides better outcomes. Here, we performed a comprehensive review of published articles that compare the clinical outcomes and costs between CLP and CLF for CSM.
A literature search was performed using PubMed, Web of Science, and Cochrane databases. Strict exclusion criteria were applied, and included articles were then assessed for publication year, study design, and significant differences in outcome variables.
From 519 studies identified with search terms, 38 studies were included for the qualitative analysis. Statistically significant differences in the clinical outcomes and costs were found in 18 studies. Eleven studies were prospective or retrospective, and 8 studies were meta-analyses. For the outcome variables of interest, results were reported by classifying into prospective studies, retrospective studies, and meta-analyses.
CLP and CLF are 2 of the most commonly performed surgical procedures for the treatment of CSM. Although CLP and CLF each provide satisfactory clinical outcomes for patients with CMS, CLP may result in better cervical range of motion and less cost, length of stay, operation time, blood loss, paraspinal muscular atrophy, and rate of nerve palsies as compared to CLF. The major limitation of CLP versus CLF comparison studies includes the heterogeneity in techniques and preoperative criteria. Thus, further validation and investigations in larger cohorts will be required.
脊髓型颈椎病（CSM）是一种导致脊髓功能进行性衰退的退行性疾病。颈椎椎板成形术（CLP）和颈椎椎板切除融合术（CLF）是多节段CSM的标准治疗方法。然而，一种手术是否比另一种手术能带来更好的疗效仍不明确。在此，我们对已发表的比较CLP和CLF治疗CSM的临床疗效及费用的文章进行了全面综述。
使用PubMed、科学网和Cochrane数据库进行文献检索。应用严格的排除标准，然后对纳入的文章进行出版年份、研究设计及结局变量显著差异的评估。
通过检索词共识别出519项研究，其中38项研究纳入定性分析。18项研究发现临床疗效和费用存在统计学显著差异。11项研究为前瞻性或回顾性研究，8项研究为荟萃分析。对于感兴趣的结局变量，按前瞻性研究、回顾性研究和荟萃分析进行结果报告。
CLP和CLF是治疗CSM最常用的两种手术方法。虽然CLP和CLF对CMS患者均能提供满意的临床疗效，但与CLF相比，CLP可能带来更好的颈椎活动度，且在费用、住院时间、手术时间、失血量、椎旁肌萎缩及神经麻痹发生率方面更低。CLP与CLF比较研究的主要局限性包括技术和术前标准的异质性。因此，需要在更大队列中进行进一步验证和研究。
