Cervical laminectomy versus laminoplasty: is there a difference in outcome and post-operative pain?

Cervical laminectomy versus laminoplasty: is there a difference in outcome and post-operative pain?

Neurosurgery. 2011 Oct 19;

Authors: Nurboja B, Kachramanoglou C, Choi D

Abstract
BACKGROUND: Cervical laminoplasty is often used for the decompression of multilevel cervical spondylotic myelopathy without creating spinal instability and kyphosis. OBJECTIVE: To assess the axial pain, quality of life, sagittal alignment and extent of decompression after standard cervical laminectomy or laminoplasty. We further evaluate if the sagittal alignment changes over time after both procedures, and if axial pain depends on sagittal alignment. METHODS: We reviewed 268 patients with cervical radiculopathy or myelopathy who had standard cervical laminectomy or laminoplasty between January 1999 and January 2009. The clinical outcome was analyzed by Visual analogue scale (VAS) for neck pain. The quality of life was analyzed by EQ5D questionnaire. The degree of deformity and extent of decompression were assessed using the Ishihara index and Pavlov’s ratio, respectively. RESULTS: Laminoplasty was associated with more neck pain and worse quality of life when four or more levels were decompressed, compared to the laminectomy group. For operations of three or fewer levels, there was no difference. Interestingly, the radiological effectiveness of decompression was greater in the laminoplasty group. CONCLUSION: Laminoplasty for four or more cervical levels was associated with more axial pain, and consequently poorer quality of life than laminectomy. There was a similar loss of sagittal alignment in both the laminectomy and laminoplasty groups over time. Our results suggest there is no clear benefit of laminoplasty over laminectomy in patients who do not have spinal instability.

PMID: 22015812 [PubMed – as supplied by publisher]

Effect of a single dose of pregabalin on post-operative pain and pre-operative anxiety in patients undergoing discectomy.

Effect of a single dose of pregabalin on post-operative pain and pre-operative anxiety in patients undergoing discectomy.

Acta Anaesthesiol Scand. 2011 Mar 8;

Authors: Spreng UJ, Dahl V, Raeder J

Background: Pregabalin acts as a membrane stabilizer and has both analgesic and anxiolytic effects. We hypothesized that one pre-operative dose of pregabalin would reduce pre-operative anxiety and post-operative pain in patients undergoing discectomy. Methods: We performed a randomized, placebo-controlled study of 150?mg pregabalin administered before lumbar discectomy in general anaesthesia. The primary endpoint was pain at rest [visual analogue scale (VAS)] 120?min after surgery. The secondary outcomes were morphine consumption, pre-operative anxiety (VAS) and the occurrence of side effects. Results: The VAS scores for pain at rest and morphine consumption were higher in the placebo group during the 4-h stay in the post-anaesthetic care unit (PACU), but did not differ significantly 24?h after surgery. Pain scores at 7 days were similar and there was no difference in the occurrence of side effects. Pre-operative anxiety was significantly lower in the pregabalin group (2.23±1.11 vs. 4.17±2.37, 95% confidence interval: 0.82-3.05, P=0.001) and there was a significant positive correlation between the pre-operative anxiety score and post-operative pain at 120?min in the pregabalin group. Conclusions: A single dose of pregabalin (150?mg) reduced post-operative pain at rest and morphine consumption during the PACU period after lumbar discectomy. Pre-operative anxiety was lower, without increased incidence of side effects.

PMID: 21385158 [PubMed – as supplied by publisher]