Comparison Of Expansion Open-door Laminoplasty With Foraminotomy (EOLF) With Anterior Cervical Discectomy And Fusion (ACDF) For Multilevel Cervical Myelopathy Associated With One-sided Radiculopathy:a Short-term Outcome Study

Background:Multilevel cervical myelopathy associated with one-sided radiculopathy is due to degenerative process and aging of the cervical spine resulting in cervical and root canal stenosis, which causes compression of spinal cord and nerve root tissues. Surgical decompression is the treatment of choice. At present, there are two surgical procedures commonly described in the literatures:anterior cervical discectomy with fusion (ACDF) and laminoplasty. The traditional posterior laminoplasty does not relieve foraminal stenosis causing nerve root compression, whereas in case of ACDF, the adjacent disk degeneration is accelerated. Here in this study we combined foraminotomy along with traditional expansion open-door laminoplasty and compared the outcomes of ACDF and expansion open-door laminoplasty with foraminotomy (EOLF). Till date no any studies have compared the clinical outcomes between ACDF and EOLF for the treatment of multilevel cervical radiculomyelopathy.Study Design:Single centered clinical prospective comparative study.Objective:To compare the short-term clinical and radiological outcomes between expansion open-door laminoplasty with foraminotomy (EOLF) and anterior cervical discectomy with fusion (ACDF) for the treatment of multi-level cervical myelopathy associated with one-sided radiculopathy.Materials and Methods:60patients of multilevel cervical myelopathy associalted with one-sided radiculopathy were allocated in this study. All patients were randomly grouped into ACDF and EOLF group, and we prospectively performed ACDF (n=29) and EOLF (n=31) from December2011to December2012. All patients were followed-up for one year postoperatively. The Japanese Orthopedics Association (JOA) score and recovery rate were evaluated. For radiographic evaluation, the lordotic angle and range of motion (ROM) at C2-C7were investigated. Intra-operative blood loss, operative time and postoperative complications were also recorded.Results:Only55patients (EOLF/ACDF:28/27) could be followed for at least one year with a follow-up rate of91.6%. Patients’demographics were similar between the two groups. EOLF group had significant shorter operating time (178vs.144min) and less bleeding (192vs.175mL) as compared with ACDF group (P<0.05). There were fewer complications in EOLF group than that of ACDF group. Results of JOA score and recovery rate, at one-year postoperative follow-up, showed no statistical difference in both groups. Cervical lordosis of ACDF increased from13.7to16.2degrees, whereas that of EOLF group decreased from14.6to13.3degrees (P<0.05). The percentage of range of motion declined in the2groups (ACDF/EOLF),42.6%versus25.5%(P<0.05).Conclusion:While treating Multi-segmental Cervical Radiculomyelopathy, ACDF and EOLF had similar clinical outcomes. However, EOLF group demonstrated shorter operative time, less blood loss, and fewer complications than ACDF group. Lordosis was maintained better in ACDF group but there was accelerated adjacent segment degeneration. EOLF was found to be better to retain postoperative ROM. Therefore EOLF seems to be an effective and safer method in the management of Multi-segment Cervical Radiculomyelopathy.