Surgical Technique at C3 Does Not Influence Loss of Cervical Lordosis Following Laminoplasty: C3 Partial "Dome" Laminectomy versus C3 Laminoplasty

Introduction: Preservation of soft tissue attachments at the rostral segment of multilevel laminoplasty using partial C3 “dome” laminectomy instead of C3 laminoplasty has been suggested to result in less postoperative kyphosis. It is unknown if a C3 partial laminectomy above the laminoplasty bed affects loss of cervical lordosis.

Methods: Patients undergoing multilevel laminoplasty of the sub-axial cervical spine (C3-C7) at a single institution were retrospectively reviewed. Patients were divided into two cohorts based on surgical technique at the rostral level: C3 laminoplasty (N=61) and C3 partial “dome” laminectomy (N=39). The primary outcome measure was analyzed as an ordinal variable: unchanged ( < 5°), mild loss (5°-10°), and moderate loss (>10°) of cervical lordosis. All patients had at least 1-year postoperative X-rays.

Results: Of 100 patients, 31% (n=31) had loss of cervical lordosis >5°. The C3 laminoplasty versus C3 partial "dome laminectomy did not differ with respect to loss of cervical lordosis: 65.5% vs 74.3% no change, 14.7% vs 10.2% mild change, and 19.6% vs 15.3% moderate change, respectively (p=0.644). Except for older age in the C3 laminoplasty cohort (66.3 vs 59.4 years, p=0.006), demographic data was equivalent between the two surgical techniques. None of the preoperative or postoperative radiographic parameters differed between the 2 cohorts. When controlling for age, ordinal regression showed that surgical technique at the C3 level did not affect the odds of postoperative loss of lordosis. One patient with C3 laminectomy experienced postoperative kyphosis requiring reoperation within 1 year after the index surgery. Two patients in each cohort required readmission within 90 days after surgery.

Conclusion : There was no difference in postoperative loss of cervical lordosis in patients who underwent either C3 laminoplasty or C3 partial “dome” laminectomy at the rostral segment of multilevel cervical laminoplasty. Radiographic and surgical outcomes were equivalent between the two groups.