Which Technique Is Better Option for C3 Segment in Multilevel Open-Door Laminoplasty of the Cervical Spine?

Study Design. A post-hoc comparative study. Objective. To evaluate postoperative clinical, radiological, and surgical outcomes after laminoplasty (LP) involving the C3 segment and to compare outcomes with those of patients who underwent LP with C3 laminectomy (LN). Summary of Background Data. In many of the pathologies that require LP involving C3 segment, most spine surgeons perform LP at C3 and other cervical segments. Considering the peculiarities of the C2-C3 level, spine surgeons should take into account those in LP involving the C3 segment, but the particular aspects of the C2-C3 levels have not been fully evaluated. Methods. Of 93 patients, 66 patients (39 in group A, LP involving C3; 27 in group B, LP with C3 LN) were enrolled in the study. The primary outcome measure was pain intensity of the posterior neck measured with visual analog scale. Secondary endpoints included the following: (1) radiologic outcomes based on the cervical range of motion and rate of bony impingement and spontaneous fusion between C2 and C3, (2) clinical outcomes based on the 12-item short-form health survey and Japanese Orthopedic Association scale, and (3) surgical outcomes. Results. The primary end-point of the present study, posterior neck pain, exhibited a greater improvement in the group with C3 LN than in the group with C3 LP at 6 months and 1 year after surgery (P = 0.03 and 0.01, respectively). The cervical range of motion of C3 LN group was significantly greater than C3 LP group at postoperative 1 year (P = 0.02). Radiologic evidences of bony impingement and spontaneous fusion between C2 and C3 were significantly greater in C3 LP group than in C3 LN group. Clinical outcomes and surgical outcomes did not differ significantly between groups. Conclusion. We recommend performing LN instead of LP for the C3 segment in cases requiring multilevel LP surgery involving C3.