Surgical Outcomes Following Laminectomy With Fusion Versus Laminectomy Alone in Patients With Degenerative Cervical Myelopathy
Bibliographic record
Abstract
STUDY DESIGN: .: Post-hoc analysis of a prospective observational cohort study. OBJECTIVE: .: To compare clinical outcomes following laminectomy and fusion versus laminectomy alone in an international series of individuals suffering from degenerative cervical myelopathy (DCM). SUMMARY OF BACKGROUND DATA: .: Significant controversy exists regarding the role of instrumented fusion in the context of posterior surgical decompression for DCM. A previous study comparing laminectomy and fusion with laminoplasty showed no differences in outcomes between groups after adjusting for preoperative characteristics. METHODS: .: Based on the operation they received, 208 of the 757 patients prospectively enrolled in the AO Spine North America or International studies at 26 global sites were included in the present study. Twenty-two patients were treated with laminectomy alone and 186 received a laminectomy with fusion. Patients were evaluated using the modified Japanese Orthopedic Association scale (mJOA), Nurick score, Neck Disability Index, and SF36 quality of life measure. Baseline and surgical characteristics were compared using a t test for continuous variables and a chi-square test for categorical variables. A mixed model analytic approach was used to evaluate differences in outcomes at 24 months between patients undergoing laminectomy and fusion versus laminectomy alone. RESULTS: .: Surgical cohorts were comparable in terms of preoperative patient characteristics. Patients undergoing laminectomy with instrumented fusion had a significantly longer operative duration (P < 0.0001, 231.44 vs. 107.10 min) but a comparable length of hospital stay. In terms of outcomes, patients treated with laminectomy with fusion exhibited clinically meaningful improvements (in functional impairmentΔmJOA = 2.48, ΔNurick = 1.19), whereas those who underwent a laminectomy without fusion did not (ΔmJOA = 0.78; ΔNurick = 0.29). There were significant differences between surgical cohorts in the change in mJOA and Nurick scores from preoperative to 24-months postoperative (mJOA: -1.70, P = 0.0266; Nurick: -0.90, P = 0.0241). The rate of perioperative complications was comparable (P = 0.879). CONCLUSION: .: Our findings suggest that cervical laminectomy with instrumented fusion is more effective than laminectomy alone at improving functional impairment in patients with DCM. These results warrant confirmation in larger prospective comparative studies. LEVEL OF EVIDENCE: 2.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".