Laminectomy vs. laminoplasty for treating multi-segment cervical canal stenosis combined with central cord syndrome in the absence of fracture or dislocation: a retrospective study.

BACKGROUND

Laminectomy fusion fixation (LF) and single open-door laminoplasty (LP) are common posterior surgeries for central cord syndrome without fracture/dislocation (CCSWOFD), yet a comprehensive comparison is lacking. This study compared outcomes of LF vs. LP for multi-segmental cervical canal stenosis with CCSWOFD.

METHODS

A retrospective analysis was conducted on 112 patients (LF group, n = 59; LP group, n = 53). Clinical and radiological outcomes were assessed. A post-hoc power analysis was performed, and multivariate logistic regression was used to identify factors associated with favorable outcomes, adjusting for key confounders.

RESULTS

The LF group demonstrated significantly better final Japanese Orthopaedic Association (JOA) scores, recovery rates (RR), intrinsic hand muscle strength (IHMS), and Brain and Spinal Injury Center (BASIC) scores compared to the LP group (P < 0.05). LF also achieved superior postoperative C2-7 Cobb angles despite reduced range of motion (ROM). The sagittal vertical axis (SVA) decreased significantly in the LF group but increased in the LP group. Notably, LF showed superior IHMS and RR outcomes in K-line (-) patients. Complication rates did not differ significantly between groups. Multivariate analysis identified higher preoperative JOA and IHMS as independent protective factors for favorable recovery, while LF was associated with non-significantly greater odds of good outcomes after adjusting for confounders.

CONCLUSION

Both LF and LP effectively improved neurological function, alleviated pain, enhanced motor ability, and reduced spinal cord edema in CCSWOFD patients with multi-segment stenosis. In this retrospective cohort, laminectomy fusion fixation was associated with superior neurological and radiological outcomes compared to laminoplasty for multi-segment CCSWOFD, particularly for patients with coexisting ossification of the posterior longitudinal ligament and K-line (-).