Considering a neck fusion? Tens of thousands of patients a year find themselves making the same decision. Now a new study raises more questions about neck fusion to treat spinal cord compression.
Understanding Cervical Spinal Cord Compression
Cervical spondylotic myelopathy means that there is a compression of the spinal cord in the neck by bone spurs. This can occur over time with wear and tear as we age, and it can also be due to any number of conditions, such as degenerative disc disease or herniated discs or even an injury of some sort. As the condition advances or progresses to multiple levels, surgery is often discussed. One surgery you might be presented with is a laminectomy with fusion, and another is a laminoplasty. Let’s examine both.
What Is a Laminectomy with Fusion?
Laminectomy involves removing the entire lamina, or unroofing the house as I explained in an analogy, here, a couple of months ago. Think of the spinal canal as a house with the roof being the lamina and the spinal cord inside the house and the spinal nerves exiting the windows on either side. The vertebra and disc make up the floor of the house.
The purpose of the surgery is to provide more space for and relieve pressure on the spinal cord. To do this, you can remove the roof of the house (laminectomy). The vertebrae or discs can also create pressure at the same site, but from the other side of the spinal column (or the floor).
Sometimes a fusion is done in conjunction with the laminectomy. A fusion involves removing the disc between two or more vertebrae and using hardware to bolt the vertebrae together to encourage them to fuse. In other words, two or more vertebrae are forced to permanently grow together into one solid piece of bone.
What Is a Laminoplasty?
A laminoplasty is also done to relieve pressure on the spinal cord. The surgery is performed in the neck for cervical myelopathy. One side of the lamina is cut, while a groove is placed in the opposite side, essentially allowing the roof of the house to be opened as if on a hinge. This decompresses the cervical portion of the spinal cord, which lives underneath the laminae in the neck. In other words, it gives the spinal cord more space in the spinal canal. This is typically performed at multiple cervical levels, so not just one but multiple laminae are cut.
One new study put laminectomy with fusion and laminoplasty head to head to determine which surgery was the better option for multilevel cervical spondylotic myelopathy. Let’s review what was found.
Laminectomy with Fusion vs. Laminoplasty for Cervical Spine Compression
The new study was a meta-analysis consisting of 15 separate studies. Outcome and safety results from a total of 555 patients who had laminectomy with fusion and 576 who had laminoplasty were reviewed. The results? Laminectomy with fusion was not only a more lengthy surgery compared to laminoplasty, but it was also associated with higher complication rates and more blood loss during surgery. The laminectomy/fusion patients also experienced decreased range of motion in the neck when compared to their laminoplasty counterparts.
Laminoplasty May Be the Lesser of Two Evils
So if you have to choose one surgery or the other for cervical spondylotic myelopathy, it looks like the laminoplasty is the lesser of two evils; however, invasive surgery is still invasive surgery. While this study states that both surgeries are effective options for multilevel cervical spondylotic myelopathy, multiple studies on fusion in general have shown otherwise:
- Fusion has been shown to be no more effective for pain and other outcomes than a sham surgery.
- Fusion surgery may only lead to more fusion surgeries.
- Adding a fusion to a laminectomy procedure has been found to be no more effective than just having the laminectomy alone.
- Spinal decompression (aka laminectomy) may relieve pressure on the spinal cord, but it can also damage the local muscles that help support the spine, resulting in instability.
Learn more about the muscle damage to the multifidus (the big hole) that can occur with any of these back surgeries in my video below:
Learn more about laminectomy and fusion, including adjacent segment disease (often covered on this blog), in my video below:
The upshot? More and more research is showing that spinal fusions aren’t needed. So please do your homework before signing up for one!