C3-6 laminoplasty takes over C3-7 laminoplasty with significantly lower incidence of axial neck pain

Abstract

Five-lamina (C3-7) procedure is the most popular cervical laminoplasty and there have been no studies on the most appropriate number of laminae to be opened. We prospectively reduced the range of laminoplasty from C3-7 to C3-6 in 2002 and compared the outcome of C3-6 laminoplasty (n=37) to that of C3-7 laminoplasty (n=28). In both groups, neurological gain was satisfactory, radiographic changes were minimal, and postoperative MRI indicated sufficient expansion of the dura and the spinal cord. Average operating period was significantly shorter, and length of the operative wound was significantly less in the C3-6 group than in the C3-7 group. Postoperative axial neck pain was significantly rarer after C3-6 laminoplasty than after C3-7 laminoplasty (5.4% vs. 29%, P=0.015). Due to its simplicity and various benefits, C3-6 laminoplasty is a promising alternative to conventional C3-7 laminoplasty for treatment of multisegmental compression myelopathy.

Axial pain after posterior cervical spine surgery: a systematic review

“…Sakaura et al [34] found that the muscles at the cervicothoracic junction around the C7 spinous process played a central role in the development of this postoperative axial pain. Consequently, axial pain inherent in laminoplasty was reported to be reduced by preserving the C7 spinous process and its muscle and ligament attachments [6,7,32,42]. Furthermore, Hosono et al [9] revealed that C7, rather than the deep extensor muscles, was significantly related to axial pain.…”

“…These modifications aim at protecting the muscular attachment to spinous process and reconstruct the posterior structures. The reconstructive techniques [7,22,31,32,39,41,47] include reattachment of the spinous processes and musculatures, and preservation of deep extensor muscles and C2 or C7 spinous processes. Clinical studies have showed the advantages of these techniques over open-door laminoplasty in reducing axial pain and increasing cervical physiological lordosis.…”

“…The severity of axial pain was increased in the sitting or standing position and decreased in the supine position. Downward displacement of the upper extremities may induce axial pain in the sitting position [7]. Most of the patients experienced neck and shoulder pain in the early postoperative stages, and then these symptoms subsided gradually [10,22,42,48].…”

“…One study [31] showed postoperative aggravation of axial pain, whereas five [1,2,11,25,42] reported pain alleviation. Three studies [7,9,36] focused on early axial pain and late axial pain after surgery found that the frequencies of early axial pain were higher than late axial pain.…”

“…Thirteen studies compared surgical approaches to determine which approach would significantly reduce the incidence or severity of axial pain ( Table 2). The results of 8 of these 13 studies [7,17,22,31,[40][41][42]44] suggested that modified laminoplasty produced less axial pain than conventional laminoplasty. Modified laminoplasty included less invasive surgery and reconstructive technique.…”