Evidence-based treatment for multilevel cervical spondylotic myelopathy_West China Medical Journal

Authors：

LIU Yin ,  KONG Qingquan

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

KONG Qingquan, Email: Kongspine@126.com

Keywords：

Expansive open-door laminoplasty; Cervical spondylotic myelopathy; Ossification of the posterior longitudinal ligament; Evidence-based practice

DOI：

10.7507/1002-0179.201512019

Video：

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Objective To investigate an individualized treatment program of a patient with multilevel cervical spondylotic myelopathy by the method of evidence-based medicine. Methods One patient with multilevel cervical spondylotic myelopathy was admitted into West China Hospital on October 19th, 2015. After evaluating the patient’s condition adequately, we proposed the problem according to the " patient, intervention, control, and outcome” (PICO) principles. Then, we searched and evaluated the systematic reviews, randomized controlled trials (RCTs), cohort studies from Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Medline, Embase, PubMed, OVID ACP Journal Club, CNKI, Wanfang and so on. The search date was from January 1991 to December 2015. And the best evidences from the databases were utilized in clinical practice. Results Twelve studies (five systematic reviews, two RCTs, four cohort studies and one latest guideline) were listed. To patients with multilevel cervical spondylotic myelopathy with ossification of the posterior longitudinal ligament (OPLL), posterior laminoplasty was less traumatic and had less complication. Expansive open-door laminoplasty was better. And the use of mini-plate fixation also reduced the related complications. Conclusions Posterior expansive open-door laminoplasty with mini-plate fixation has less traumatic and complication incidence, which can treat multilevel cervical spondylotic myelopathy effectively. For the best results and avoiding adverse outcomes, the procedure should be preferred in patients with OPLL.

Citation： LIU Yin, KONG Qingquan. Evidence-based treatment for multilevel cervical spondylotic myelopathy. West China Medical Journal, 2017, 32(9): 1383-1386. doi: 10.7507/1002-0179.201512019 Copy

1.	Seifert V, Stolke D. Multisegmental cervical spondylosis: treatment by spondylectomy, microsurgical decompression, and osteosynthesis. Neurosurgery, 1991, 29(4): 498-503.
2.	Lian XF, Xu JG, Zeng BF, et al. Noncontiguous anterior decompression and fusion for multilevel cervical spondylotic myelopathy: a prospective randomized control clinical study. Eur Spine J, 2010, 19(5): 713-719.
3.	Woods BI, Hohl J, Lee J, et al. Laminoplasty versus laminectomy and fusion for multilevel cervical spondylotic myelopathy. Clin Orthop Relat Res, 2011, 469(3): 688-695.
4.	Guo Q, Bi X, Ni B, et al. Outcomes of three anterior decompression and fusion techniques in the treatment of three-level cervical spondylosis. Eur Spine J, 2011, 20(9): 1539-1544.
5.	Konya D, Ozgen S, Gercek A, et al. Outcomes for combined anterior and posterior surgical approaches for patients with multisegmental cervical spondylotic myelopathy. J Clin Neurosci, 2009, 16(3): 404-409.
6.	Li ZH, Huang JC, Zhang ZZ, et al. A comparison of multilevel anterior cervical discectomy and corpectomy in patients with 4-level cervical spondylotic myelopathy: a minimum 2-year follow-up study: multilevel anterior cervical discectomy. Clin Spine Surg, 2017, 30(5): E540-E546.
7.	Lin Q, Zhou X, Wang X, et al. A comparison of anterior cervical discectomy and corpectomy in patients with multilevel cervical spondylotic myelopathy. Eur Spine J, 2012, 21(3): 474-481.
8.	Liu X, Wang H, Zhou Z, et al. Anterior decompression and fusion versus posterior laminoplasty for multilevel cervical compressive myelopathy. Orthopedics, 2014, 37(2): e117-e122.
9.	Zhu B, Xu Y, Liu X, et al. Anterior approach versus posterior approach for the treatment of multilevel cervical spondylotic myelopathy: a systemic review and meta-analysis. Eur Spine J, 2013, 22(7): 1583-1593.
10.	Liu X, Min S, Zhang H, et al. Anterior corpectomy versus posterior laminoplasty for multilevel cervical myelopathy: a systematic review and meta-analysis. Eur Spine J, 2014, 23(2): 362-372.
11.	Heller JG, Raich AL, Dettori JR, et al. Comparative effectiveness of different types of cervical laminoplasty. Evid Based Spine Care J, 2013, 4(2): 105-115.
12.	Wang S J, Jiang S D, Jiang L S, et al. Axial pain after posterior cervical spine surgery: a systematic review. Eur Spine J, 2011, 20(2): 185-194.
13.	Okada M, Minamide A, Endo T, et al. A prospective randomized study of clinical outcomes in patients with cervical compressive myelopathy treated with open-door or French-door laminoplasty. Spine (Phila Pa 1976), 2009, 34(11): 1119-1126.
14.	Wang L, Song Y, liu L, et al. Clinical outcomes of two different types of open-door laminoplasties for cervical compressive myelopathy: a prospective study. Neurol India, 2012, 60(2): 210-216.
15.	Yue WM, Tan CT, Tan SB, et al. Results of cervical laminoplasty and a comparison between single and double trap-door techniques. J Spinal Disord, 2000, 13(4): 329-335.
16.	Naito M, Ogata K, Kurose S, et al. Canal-expansive laminoplasty in 83 patients with cervical myelopathy. A comparative study of three different procedures. Int Orthop, 1994, 18(6): 347-351.
17.	Fujibayashi S, Neo M, Yoshida M, et al. Neck muscle strength before and after cervical laminoplasty: relation to axial symptoms. J Spinal Disord Tech, 2010, 23(3):197-202.
18.	Ohya J, Oshima Y, Takeshita K, et al. Patient satisfaction with double-door laminoplasty for cervical compression myelopathy. J Orthop Sci, 2015, 20(1): 64-70.
19.	中国康复医学会颈椎病专业委员会. 颈椎病诊治与康复指南. 北京: 中国康复医学会, 2010: 1-22.

1. Seifert V, Stolke D. Multisegmental cervical spondylosis: treatment by spondylectomy, microsurgical decompression, and osteosynthesis. Neurosurgery, 1991, 29(4): 498-503.
2. Lian XF, Xu JG, Zeng BF, et al. Noncontiguous anterior decompression and fusion for multilevel cervical spondylotic myelopathy: a prospective randomized control clinical study. Eur Spine J, 2010, 19(5): 713-719.
3. Woods BI, Hohl J, Lee J, et al. Laminoplasty versus laminectomy and fusion for multilevel cervical spondylotic myelopathy. Clin Orthop Relat Res, 2011, 469(3): 688-695.
4. Guo Q, Bi X, Ni B, et al. Outcomes of three anterior decompression and fusion techniques in the treatment of three-level cervical spondylosis. Eur Spine J, 2011, 20(9): 1539-1544.
5. Konya D, Ozgen S, Gercek A, et al. Outcomes for combined anterior and posterior surgical approaches for patients with multisegmental cervical spondylotic myelopathy. J Clin Neurosci, 2009, 16(3): 404-409.
6. Li ZH, Huang JC, Zhang ZZ, et al. A comparison of multilevel anterior cervical discectomy and corpectomy in patients with 4-level cervical spondylotic myelopathy: a minimum 2-year follow-up study: multilevel anterior cervical discectomy. Clin Spine Surg, 2017, 30(5): E540-E546.
7. Lin Q, Zhou X, Wang X, et al. A comparison of anterior cervical discectomy and corpectomy in patients with multilevel cervical spondylotic myelopathy. Eur Spine J, 2012, 21(3): 474-481.
8. Liu X, Wang H, Zhou Z, et al. Anterior decompression and fusion versus posterior laminoplasty for multilevel cervical compressive myelopathy. Orthopedics, 2014, 37(2): e117-e122.
9. Zhu B, Xu Y, Liu X, et al. Anterior approach versus posterior approach for the treatment of multilevel cervical spondylotic myelopathy: a systemic review and meta-analysis. Eur Spine J, 2013, 22(7): 1583-1593.
10. Liu X, Min S, Zhang H, et al. Anterior corpectomy versus posterior laminoplasty for multilevel cervical myelopathy: a systematic review and meta-analysis. Eur Spine J, 2014, 23(2): 362-372.
11. Heller JG, Raich AL, Dettori JR, et al. Comparative effectiveness of different types of cervical laminoplasty. Evid Based Spine Care J, 2013, 4(2): 105-115.
12. Wang S J, Jiang S D, Jiang L S, et al. Axial pain after posterior cervical spine surgery: a systematic review. Eur Spine J, 2011, 20(2): 185-194.
13. Okada M, Minamide A, Endo T, et al. A prospective randomized study of clinical outcomes in patients with cervical compressive myelopathy treated with open-door or French-door laminoplasty. Spine (Phila Pa 1976), 2009, 34(11): 1119-1126.
14. Wang L, Song Y, liu L, et al. Clinical outcomes of two different types of open-door laminoplasties for cervical compressive myelopathy: a prospective study. Neurol India, 2012, 60(2): 210-216.
15. Yue WM, Tan CT, Tan SB, et al. Results of cervical laminoplasty and a comparison between single and double trap-door techniques. J Spinal Disord, 2000, 13(4): 329-335.
16. Naito M, Ogata K, Kurose S, et al. Canal-expansive laminoplasty in 83 patients with cervical myelopathy. A comparative study of three different procedures. Int Orthop, 1994, 18(6): 347-351.
17. Fujibayashi S, Neo M, Yoshida M, et al. Neck muscle strength before and after cervical laminoplasty: relation to axial symptoms. J Spinal Disord Tech, 2010, 23(3):197-202.
18. Ohya J, Oshima Y, Takeshita K, et al. Patient satisfaction with double-door laminoplasty for cervical compression myelopathy. J Orthop Sci, 2015, 20(1): 64-70.
19. 中国康复医学会颈椎病专业委员会. 颈椎病诊治与康复指南. 北京: 中国康复医学会, 2010: 1-22.

West China Medical Journal

Evidence-based treatment for multilevel cervical spondylotic myelopathy

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