Efficacy and safety of laminoplasty combined with C3 laminectomy for patients with multilevel degenerative cervical myelopathy: a systematic review and meta-analysis.

Publisher: Springer-Verlag Country of Publication: Germany NLM ID: 9301980 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1432-0932 (Electronic) Linking ISSN: 09406719 NLM ISO Abbreviation: Eur Spine J Subsets: MEDLINE

Original Publication: Heidelberg, Federal Republic of Germany : Springer-Verlag, c1992-

Cervical Vertebrae*/surgery ; Laminectomy*/adverse effects ; Laminectomy*/methods ; Laminoplasty*/adverse effects ; Laminoplasty*/methods ; Spinal Cord Diseases*/etiology ; Spinal Cord Diseases*/surgery ; Spondylosis*/complications ; Spondylosis*/surgery; Humans ; Decompression, Surgical/adverse effects ; Decompression, Surgical/methods ; Treatment Outcome

Purpose: Laminoplasty (LP) combined with C3 laminectomy (LN) can effectively achieve spinal cord decompression while maintaining the integrity of the posterior ligament-muscle complex, thereby minimizing cervical muscle damage. However, its necessity and safety remain controversial. This study aimed to compare the safety and efficacy of LP and LP combined with C3 LN in the treatment of patients with multilevel degenerative cervical spondylotic myelopathy (DCM).
Methods: A systematic review and meta-analysis of the literature was performed. A search of PubMed, Web of Science, Embase, and the Cochrane Library databases was conducted from inception through December 2023 and updated in February 2024. Search terms included laminoplasty, laminectomy, C3 and degenerative cervical spondylosis. The literature search yielded 14 studies that met our inclusion criteria. Outcomes included radiographic results, neck pain, neurologic function, surgical parameters, and postoperative complications. We also assessed methodologic quality, publication bias, and quality of evidence.
Results: Fourteen studies were identified, including 590 patients who underwent LP combined with C3 LN (modified group, MG) compared to 669 patients who underwent LP (traditional group, TG). The results of the study indicated a statistically significant improvement in cervical range of motion (WMD = 3.62, 95% CI: 0.39 to 6.85) and cervical sagittal angle (WMD = 2.07, 95% CI: 0.40 to 3.74) in the MG compared to the TG at the last follow-up (very low-level evidence). The TG had a higher number of patients with complications, especially C2-3 bone fusion. There was no significant difference found in improvement of neck pain, JOA, NDI, cSVA, T1 slope at latest follow-up.
Conclusion: LP combined with C3 LN is an effective and necessary surgical method for multilevel DCM patients to maintain cervical sagittal balance. However, due to the low quality of evidence in existing studies, more and higher quality research on the technology is needed in the future.
(© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

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20204Y0165, 20224Y0165 Project of Shanghai Municipal Health Commission; 82205145 National Natural Science Foundation of China; 2023-062 Shanghai "Rising Stars of Medical Talents"-Youth Development Program-Youth Medical Talents-Specialist Program SHWSRS; 2023-QNRC2-A03 Project of Chinese Society of Traditional Chinese Medicine youth talent lifting

Keywords: C3; Degenerative cervical myelopathy; Laminectomy; Laminoplasty; Meta-analysis

Date Created: 20240809 Date Completed: 20241015 Latest Revision: 20241101

20241102

10.1007/s00586-024-08444-x

39122847