title: Can C3 Laminectomy Reduce Interlaminar Bony Fusion and Preserve the Range of Motion After Cervical Laminoplasty?
abstract: METHODS
  Retrospective comparative study.
  
  
  OBJECTIVE
  To investigate whether the resection of C3 lamina during cervical laminoplasty can prevent C2-C4 interlaminar bony fusion and preserve the range of motion (ROM) postoperatively.
  
  
  BACKGROUND
  Interlaminar bony fusion is a common complication after cervical laminoplasty, especially in the C2-C4. Laminectomy, rather than laminoplasty, of C3 has been recently introduced. Its advantages include minimizing muscle detachment at C2 and reducing postoperative neck pain.
  
  
  METHODS
  A total of 59 patients with cervical spondylotic myelopathy that involved three or more levels, including C3, were consecutively treated with laminoplasty and followed up for more than 3 years after surgery. The first 45 patients underwent open-door laminoplasty at C3 (Lp group) and the subsequent 14 patients underwent laminectomy at C3 rather than laminoplasty (Ln group). The Lp group was further divided into two subgroups based on the development of interlaminar bony fusion at C2-C3 and/or C3-C4: Lp-NF (nonfusion) and Lp-F (fusion) groups. Clinical outcomes and radiographic parameters were assessed pre- and postoperatively.
  
  
  RESULTS
  Nineteen out of 45 patients who underwent laminoplasty demonstrated fusion at 3-year follow up. Fusion developed more commonly in those patients who had a smaller preoperative ROM at C2-C4 segments (Lp-F 14.3° ± 6.9° vs. Lp-NF 21.4° ± 5.3°, P = 0.013). The neck disability index (range, 13.4 ± 7.3 to 6.3 ± 5.2, P < 0.001), visual analog scale for neck pain (range, 2.5 ± 1.7 to 0.9 ± 1.3, P = 0.027), Japanese Orthopedic Association (JOA) score (range, 14.3 ± 1.9 to 16.0 ± 2.4, P < 0.001), and JOA recovery rate (63.4 ± 19.8%) in the Ln group improved postoperatively; however, there was no significant difference in the improvement of these clinical outcomes among all three groups. Postoperative cervical ROM was significantly reduced in all groups; however, the extent of reduction was significantly smaller in the Ln group (10.5°; range, 44.2° ± 9.1° to 33.7 ± 6.0°) than in the Lp-NF (15.1°; range, 45.4° ± 8.5° to 30.3° ± 7.4°) or Lp-F (18.2°; range, 39.6° ± 9.3° to 21.4° ± 10.3°) groups (P < 0.05).
  
  
  CONCLUSIONS
  C3 laminectomy with laminoplasty can prevent interlaminar bony fusion at C2-C4 and, ultimately, result in better preservation of cervical ROM than C3 laminoplasty. Furthermore, it yields similar clinical outcomes when compared with C3 laminoplasty.
  
  
  METHODS
  3.
authors: Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: Dong-Ho
authors: DH
authors: Lee
authors: Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: Jae Hwan
authors: JH
authors: Cho
authors: Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: Chang Ju
authors: CJ
authors: Hwang
authors: Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: Choon Sung
authors: CS
authors: Lee
authors: Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
authors: Samuel K
authors: SK
authors: Cho
authors: Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: Jung-Ki
authors: JK
authors: Ha
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000601:surgery*; D005260:Female; D006801:Humans; D007796:Laminectomy; D065406:Laminoplasty / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D016059:Range of Motion, Articular / Q000502:physiology*; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects; D055009:Spondylosis / Q000601:surgery*; D016896:Treatment Outcome