Perioperative complications and cervical malalignment requiring revision following cervical C3 laminectomy and C4-6 laminoplasty

Background: Degenerative cervical myelopathy is one of the most common causes of spinal cord dysfunction. Cervical laminoplasty is an excellent surgical procedure that address the underlying pathology along with motion preservation with various advantages over other surgical options. While the advantages are intuitive and are being proven in multiple recent studies, concerns regarding failure still remains precluding wider utilization despite evidence to the contrary. This study evaluated perioperative complication rate, one-year radiographic outcomes, and necessity for revision surgery for radiographic failure following Cervical C3 Laminectomy and C4-6 Laminoplasty.

Methods: A retrospective review was conducted on adult patients who underwent Cervical C3 Laminectomy and C4-6 Laminoplasty from 2016 to 2023 at a high-volume institution. Exclusion criteria included cervical spine surgeries or neuromuscular disorders. Demographics and radiographic measurements were collected. Univariate and multivariate analyses were performed to assess associations between pre- and post-operative cervical measurement variables and revisions.

Results: The study included 46 patients, predominantly male (69.6 %), with an average age of 63.1 years. Comorbidities included diabetes (8.7 %) and smoking (13 %). The average BMI was 27.5. Two cases (4.3 %) required revision surgeries: one for postlaminoplasty kyphosis and the other for persistent spinal cord compression. No significant differences were found between pre- and post-operative C2-C7 sagittal vertical axis, C1-C2 lordosis, and C7 slope (p > 0.05). There was a significant difference between pre- and post-operative C2-C7 lordosis (p = 0.036). A univariate and multivariate analysis demonstrated that pre- and post-operative radiographic measurements had no significant association with revisions (p > 0.05).

Conclusion: Cervical C3 Laminectomy and C4-6 Laminoplasty demonstrated excellent perioperative safety, maintenance of sagittal alignment, and low revision rates at one-year follow-up with proper patient selection. This study further supports the routine use of laminoplasty as a reliable, less restrictive surgical option for treating cervical myelopathy in appropriately selected patients.