Cervical Laminectomy and Fusion Andrew K. Simpson, MD Cervical - PowerPoint PPT Presentation

Cervical Laminectomy and Fusion Andrew K. Simpson, MD

Cervical Laminectomy and Fusion The best treatment option for multilevel cervical stenosis (≥3 levels) without kyphosis

Multilevel Cervical Stenosis Treatments Anterior Posterior –Laminoplasty –ACDF –Laminectomy –ACDF +/- and Fusion Corpectomy Combined A/P

Multilevel Cervical Stenosis Treatments Anterior Posterior –ACDF –Laminoplasty –ACDF +/- –Laminectomy and Corpectomy Fusion –Disc Arthroplasty –MIS Laminotomy –Skip Laminectomy Combined A/P

The Good News is Everything Works

The Good News is Everything Works But there is a best answer for a particular patient…

ACDF • 1-2 levels of stenosis (3 if low pseudo risk +/- ICBG) • +/- kyphosis • Corpectomy 1 level Lowest Fusion Rate ≥ 3 Levels

Anteroposterior • Deformity • Multilevel Anterior Procedure Required – High pseudo risk – Still need dorsal decompression (retrovertebral stenosis) Highest Complication Rate

Lami / Fusion vs Laminoplasty The Evidence Lami / Fusion and Laminoplasty similar efficacy

Lami / Fusion vs Laminoplasty The Evidence Lami / Fusion with slightly greater neurological improvement, but slightly higher long-term complication

Lami / Fusion vs Laminoplasty The Evidence Lami /Fusion causes regression of ventral compressive structures

Cervical Laminectomy and Fusion in my practice…

Ideal Cervical Laminectomy and Fusion Patient #1 – > 3 level stenosis – Spondylotic with decrease pre-op ROM – Neutral subaxial cervical alignment – C2-C7 SVA >30mm

Ideal Cervical Laminectomy and Fusion Patient #1

Ideal Cervical Laminectomy and Fusion Patient #2 – Congenital Stenosis – Previous ACDF with persistent stenosis at level of ACDF and adjacent – Pseudo

Ideal Cervical Laminectomy and Fusion Patient #2

In the end, go with what you know Laminoplasty and Lami / Fusion outcomes are similar enough that you should do what you know best…

But for me… Young Myelopathic Patient ≥ 3 Levels Stenosis Congenital Canal Narrowing Acceptable Alignment Secondary or No Neck Pain

But for me…