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

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Nov 18, 2023 458 likes •659 views

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

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Cervical Laminectomy and Fusion

Andrew K. Simpson, MD

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Cervical Laminectomy and Fusion

The best treatment option for multilevel cervical stenosis (≥3 levels) without kyphosis

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Multilevel Cervical Stenosis Treatments

–ACDF –ACDF +/- Corpectomy –Laminoplasty –Laminectomy and Fusion

Combined A/P Anterior Posterior

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Multilevel Cervical Stenosis Treatments

–ACDF –ACDF +/- Corpectomy –Disc Arthroplasty –Laminoplasty –Laminectomy and Fusion –MIS Laminotomy –Skip Laminectomy

Combined A/P Anterior Posterior

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The Good News is Everything Works

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The Good News is Everything Works

But there is a best answer for a particular patient…

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ACDF

1-2 levels of stenosis (3 if

low pseudo risk +/- ICBG)

+/- kyphosis
Corpectomy 1 level

Lowest Fusion Rate ≥ 3 Levels

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Anteroposterior

Deformity
Multilevel Anterior

Procedure Required

– High pseudo risk – Still need dorsal decompression (retrovertebral stenosis)

Highest Complication Rate

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Lami / Fusion vs Laminoplasty The Evidence

Lami / Fusion and Laminoplasty similar efficacy

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Lami / Fusion vs Laminoplasty The Evidence

Lami / Fusion with slightly greater neurological improvement, but slightly higher long-term complication

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Lami / Fusion vs Laminoplasty The Evidence

Lami /Fusion causes regression of ventral compressive structures

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Cervical Laminectomy and Fusion in my practice…

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Ideal Cervical Laminectomy and Fusion Patient #1

– > 3 level stenosis – Spondylotic with decrease pre-op ROM – Neutral subaxial cervical alignment – C2-C7 SVA >30mm

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Ideal Cervical Laminectomy and Fusion Patient #1

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Ideal Cervical Laminectomy and Fusion Patient #2

– Congenital Stenosis – Previous ACDF with persistent stenosis at level of ACDF and adjacent – Pseudo

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Ideal Cervical Laminectomy and Fusion Patient #2

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In the end, go with what you know Laminoplasty and Lami / Fusion

utcomes are similar enough that you

should do what you know best…

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

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