A Feasibility Study of a New Muscle Sparing “C3 Dome-Hybrid Open-Door Laminoplasty”

Abstract

Study Design. Retrospective case series to investigate the result of a new C3 dome-hybrid open-door laminoplasty technique. Objective. This study reports the design and feasibility of a new hybrid laminoplasty technique aimed to reduce the complications of the conventional laminoplasty, with the incorporation of C3 dome-osteotomy, an open-door C4–6 instrumented laminoplasty and C7 cephalad dome-osteotomy. Summary of Background Data. Recent findings showed that the preservation of the dorsal muscles attached at either C2 or C7 cervical spine reduced the complications of C3–C7 open-door laminoplasty. Methods. A retrospective review of consecutive patients who underwent the C3 dome-hybrid laminoplasty technique by a single surgeon with at least 2 years follow-up was performed. The surgical technique was described in detail. Clinical and radiological outcome data were analyzed. Results. Twenty six patients with cervical cord compression who underwent C3 dome-hybrid laminoplasty were recruited. The mean postoperative follow-up was 45.6 ± 24.7 (24–101) months. Significant improvements were observed in the preoperative to postoperative mean Japanese Orthopaedic Association (JOA) score (13→15, P < 0.001), Nurick grade (2.3→1.2, P < 0.001), neck disability index (NDI) (23→11, P = 0.011), 36-item short form survey (SF-36) physical component score (40→46, P = 0.027), and neck visual analogue scale (VAS) (3.1→0.3, P < 0.001). There was no significant loss in cervical lordosis from 12° preoperatively to 8° at final follow-up. Postoperative cervical range of motion (ROM) was preserved at 85% and 78% of the preoperative ROM at 2 years and at final follow-up, respectively. When comparing the first 10 patients with the next 16 patients, there was a reduction in mean operation time from 252 ± 75 to 208 ± 7 minutes, mean blood loss from 359 ± 326 to 211 ± 177 mL, and median hospital stay from 7 days (interquartile range [IQR]: 34) to 5 days (IQR: 6). At final follow-up, no patients had revision surgery, spinal infection, C5 palsy, symptomatic cervical kyphosis, or axial neck pain. Conclusion. The new C3 dome-hybrid laminoplasty technique is safe, feasible, and reproducible with good clinical outcomes. This technique may be considered as an alternative to traditional laminoplasty for patients with C3–C7 multi-level myelopathic disease. Level of Evidence: 3

Multilevel Laminoplasty for CSM: Is C3 Laminectomy Better Than C3 Laminoplasty at the Superior Vertebra?

“…An additional suggestion is that performing undercutting "dome" laminectomy at C3 rather than laminoplasty provides superior muscular and ligamentous preservation at the rostral end of the laminoplasty. Liu et al [36] reported decreased loss of lordosis when employing C3 partial "dome" laminectomy. However, only 26 patients were included in this study, which did not include a comparison group.…”

“…When using skip-level plating, another group reported improved postoperative lordosis when plating at C4 and C6 rather than C3 and C5 [35]. Finally, another group reported good clinical outcomes using partial undercutting ("dome") laminectomy at C3 above C4 laminoplasty instead of C3 laminoplasty, but their study did not include a comparison group [36].…”