What is the best strategy for C3 in open-door laminoplasty: laminectomy versus laminoplasty-a systematic review and meta-analysis

Abstract

Background: Conventional open-door laminoplasty is commonly used to treat multilevel cervical disorders but often leads to complications such as loss of cervical lordosis, limited neck motion, and axial symptoms. These issues stem from the extensive disruption of musculature and structural alterations involved in conventional methods. To address these shortcomings, the modified open-door laminoplasty with C3 laminectomy technique has been developed as a modification of conventional open-door laminoplasty, with the aims to preserve the semispinalis cervicis muscle attached to the C2 spinous process, potentially improving postoperative outcomes by maintaining muscle integrity and stability of the cervical spine.

Purpose: This study seeks to evaluate the clinical benefits of modified open-door laminoplasty with C3 laminectomy in comparison to conventional open-door laminoplasty approaches.

Study design/setting: Patient Sample: patients undergoing open-door laminoplasty.

Outcome measures: The outcome measures assessed were categoried into self-report Measure including pain indices, physiologic measures including complications, and functional measures including operative time, Neck Disability Index (NDI), Japanese Orthopaedic Association (JOA) scores, length of hospital stay, and cervical range of motion (ROM).

Methods: We conducted a comprehensive search across multiple databases, including PubMed, Scopus, EMBASE, Web of Science, and the Cochrane Library, to identify randomized controlled trials (RCTs), cohort studies, and case-control studies that compare the clinical outcomes of conventional open-door laminoplasty and modified open-door laminoplasty with C3 laminectomy. Statistical analyses were performed using RevMan software to evaluate the differences between the 2 surgical techniques.

Results: Our analysis included 11 studies encompassing 873 participants. The meta-analysis revealed no significant differences between patients undergoing conventional open-door laminoplasty and modified open-door laminoplasty with C3 laminectomy regarding operation time (mean difference, MD: 5.08, 95% confidence interval, CI: -3.04 to 13.21), length of hospital stay (MD: -0.33, 95% CI: -1.43 to 0.77), JOA scores (MD: 0.18, 95% CI: -0.03 to 0.40), NDI scores (MD: -0.14, 95% CI: -4.00 to 3.72), and complication rates (risk difference, RD: 0.01, 95% CI: -0.03 to 0.04). However, participants in the group that underwent modified open-door laminoplasty with C3 laminectomy exhibited a significantly greater range of motion (MD: 4.13, 95% CI: 0.07 to 7.20) and lower postoperative pain scores (standard mean difference, SMD: -0.57, 95% CI: -1.05 to -0.10).

Conclusion: Our study suggests that modified open-door laminoplasty with C3 laminectomy improves range of motion and reduces pain compared to conventional open-door laminoplasty, with no differences in other clinical outcomes. Further studies are needed to confirm these results.

Keywords: C3 laminectomy; Cervical; Cervical myelopathy; Neck disability index; Open door laminoplasty; Range of motion.