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

Abstract

To compare the clinical outcomes of C₃ laminectomy and C₃ laminoplasty at the C₃ segment during French-door laminoplasty. The 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 C_2-3 bony fusion rate. A 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 C_2-3 bony fusion rate (P = 0.06). This 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. PROSPERO registration number is CRD42021230798 . Date of registration: February 11, 2021.