Letter to the Editor regarding: “Surgical Outcomes Following Laminectomy with Fusion versus Laminectomy Alone in Patients with Degenerative Cervical Myelopathy” by Kotter et al.
We read with interest Dr Kotter et al's1 article on laminectomy with fusion versus laminectomy alone for degenerative cervical myelopathy (DCM). We commend their use of a multicenter database with validated outcome measures. Overall, they support a rationale for laminectomy plus fusion for DCM rather than laminectomy alone.
We emphasize caution in the interpretation of their findings. DCM patients are a heterogenous group subject to multiple confounding variables with only 22 patients in the laminectomy group versus 186 in the laminectomy and fusion group. Thus, findings are not generalizable with no power calculations to detect a proportional statistical difference. Broad inclusion criteria limit generalizability with no information on symptom duration, radiological cord compression, and extent of cervical deformity. There are few baseline variables for a multicenter study, omission of systemic confounding variables, no data on center case volume and stratification. Significant selection bias exists secondary to approach, number of levels and, the decision to fuse varying hugely among the surgical community. Only a standardized randomized controlled trial can truly address this question.
Ultimately, one cannot infer based on the presented difference in outcome measures, is secondary to “impeding dynamic movement of the spinal cord” in patients undergoing fusion.
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1. Kotter MRN, Tetreault L, Badhiwala JH, et al. Surgical outcomes following laminectomy with fusion versus laminectomy alone in patients with degenerative cervical myelopathy. Spine (Phila Pa 1976)