To evaluate the clinical outcomes of a modified technique combining C3 total laminectomy, C4–C6 open-door laminoplasty, and C7 partial laminectomy (undercutting) decompression with extensive open-door laminoplasty and titanium plate fixation in the treatment of cervical spondylotic myelopathy (CSM).Methods:A retrospective analysis was conducted on 101 CSM patients scheduled to undergo posterior cervical open-door laminoplasty. They were divided into a conventional laminoplasty (C-LAMP) group (n = 50), which received conventional C3-7 open-door laminoplasty with titanium plate fixation, and a modified laminoplasty (M-LAMP ) group (n = 51), which underwent C3 laminectomy, C4–C6 open-door laminoplasty,C7 undercutting decompression, and extensive laminoplasty with titanium plate fixation. The following parameters were compared: operation time, intraoperative blood loss, postoperative drainage volume, Japanese Orthopaedic Association (JOA) scores before and after surgery, JOA improvement rate, cervical curvature and range of motion (ROM) before and after surgery, loss of cervical curvature and ROM postoperatively, visual analog scale (VAS) scores for neck pain, incidence of axial symptoms, and other postoperative complications. All surgeries were completed successfully. No significant differences were observed between the two groups in operation time, blood loss, postoperative drainage, length of hospital stay, JOA scores before and after surgery, JOA improvement rate, or overall complication rates (P > 0.05). At the 3-month follow-up, the incidence of axial symptoms was significantly lower in the M-LAMP than in the C-LAMP (5.88% 3/51 vs. 24.00% 12/50, P = 0.010). However, this difference was no longer statistically significant at 1 year (1.9% 1/51 vs. 8.0% 4/50, P = 0.884). Both groups showed some loss of cervical curvature and ROM after surgery. At 1 year, the loss of cervical curvature did not differ significantly between groups (study: -4.1±4.9 vs. control: -3.0±5.9; P = 0.329; 95% CI: -3.2,1.1). Although there was no significant difference in ROM at 1 year (34.6±10.1° vs. 32.9±9.0°; P = 0.396), the M-LAMP had significantly less ROM loss compared to the C-LAMP (-2.0±7.2° vs. 2.3±8.8°; P = 0.008; 95% CI:-7.5,-1.1). The M-LAMP—C3 total laminectomy, C4–C6 open-door laminoplasty, C7 partial laminectomy (undercutting) and extensive laminoplasty combined with titanium plate fixation—achieved similar improvements in neurological function compared to conventional open-door laminoplasty. However, by preserving the attachments of the semispinalis cervicis at C2, the cervical extensor muscles at C7, and the insertion of the nuchal ligament, this approach significantly reduced the incidence of early postoperative axial symptoms and better maintained postoperative cervical range of motion.
Gao et al. (Mon,) studied this question.