Is laminoplasty or laminectomy the best strategy for C3 segment in French-door laminoplasty? A systematic review and meta-analysis

Tiantian Chen,Xun Zhang,Fanchao Meng,Wei Zhao,Jinglong Yan,Gongping Xu

doi:10.1186/s13018-021-02596-y

Abstract

BackgroundTo compare the clinical outcomes of C3 laminectomy and C3 laminoplasty at the C3 segment during French-door laminoplasty.MethodsThe Cochrane Library, PubMed, Embase, and Web of Science databases were searched from inception to November 10, 2020 for studies comparing the clinical outcomes of two types of French-door laminoplasty in the treatment of multilevel cervical spondylotic myelopathy (MCSM). Review Manager 5.3 was used to analyze the following outcomes: operative time, intraoperative blood loss, preoperative and postoperative Japanese Orthopaedic Association (JOA) scores, recovery rate, cervical curvature, cervical range of motion (ROM), incidence of axial symptoms (AS), and C2-3 bony fusion rate.ResultsA total of eight studies involving 776 patients were included; there were 424 patients in the C3 laminectomy group and 352 patients in the C3 laminoplasty group. The results of the meta-analysis showed that the C3 laminectomy group was superior to the C3 laminoplasty group in terms of operative time (P < 0.00001), cervical ROM (P = 0.04), and incidence of AS (P < 0.0001). However, no statistically significant differences between the two groups were noted regarding intraoperative bleeding (P = 0.44), preoperative JOA score (P = 0.57), postoperative JOA score (P = 0.09), recovery rate (P = 0.25), cervical curvature (P = 0.22), and C2-3 bony fusion rate (P = 0.06).ConclusionThis meta-analysis demonstrated that both C3 laminoplasty and C3 laminectomy could effectively improve neurological function in patients with MCSM in French-door laminoplasty. However, C3 laminectomy can reduce the operative time, preserve cervical ROM, and reduce the incidence of postoperative AS.Trial registrationPROSPERO registration number is CRD42021230798.Date of registration: February 11, 2021.

Highlights

Since Kurokawa et al [1] first reported double-door laminoplasty in 1981, this technique has been continuously improved and is widely used in the treatment of posterior longitudinal ligament ossification (OPLL), developmental cervical spinal stenosis, and multilevel cervical spondylotic myelopathy (MCSM) and has achieved satisfactory results [2]
Inclusion and exclusion criteria of the studies We adopted the following criteria and studied this metaanalysis: (1) the types of studies included randomized controlled trials, retrospective analyses, or prospective cohort studies; (2) patients with MCSM diagnosed by CT and MRI, including cervical stenosis and Posterior longitudinal ligament ossification (OPLL), regardless of sex and race; (3) inclusion in the study included both the "C3 laminectomy group" and the "C3 laminoplasty group"; and (4) the follow-up period was at least 12 months
A total of 424 patients who underwent C3 laminectomy were compared with 352 patients who underwent C3 laminoplasty

Summary

Introduction

Since Kurokawa et al [1] first reported double-door laminoplasty in 1981, this technique has been continuously improved and is widely used in the treatment of posterior longitudinal ligament ossification (OPLL), developmental cervical spinal stenosis, and multilevel cervical spondylotic myelopathy (MCSM) and has achieved satisfactory results [2]. It is difficult to preserve the semispinalis cervicis (SSC) at the C2 spinous process while opening the C3 lamina in traditional French-door laminoplasty. To avoid the above problems, conventional Frenchdoor laminoplasty has been modified, namely, C4–C7 laminoplasty with C3 laminectomy, and has been widely used in the treatment of MCSM [6]. C3 laminectomy theoretically decompresses the spinal cord more adequately, prevents C3 lifting from squeezing, stimulates C2-attached muscles, and facilitates good neurological decompression while better maintaining the integrity of the structure and function of SSC. To compare the clinical outcomes of C3 laminectomy and C3 laminoplasty at the C3 segment during French-door laminoplasty

Methods

Results

Discussion

Conclusion