Is laminoplasty or laminectomy the best strategy for C(3) segment in French-door laminoplasty? A systematic review and meta-analysis

BACKGROUND: To compare the clinical outcomes of C(3) laminectomy and C(3) laminoplasty at the C(3) segment during French-door laminoplasty. METHODS: 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. RESULTS: A total of eight studies involving 776 patients were included; there were 424 patients in the C(3) laminectomy group and 352 patients in the C(3) laminoplasty group. The results of the meta-analysis showed that the C(3) laminectomy group was superior to the C(3) 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). CONCLUSION: This meta-analysis demonstrated that both C(3) laminoplasty and C(3) laminectomy could effectively improve neurological function in patients with MCSM in French-door laminoplasty. However, C(3) laminectomy can reduce the operative time, preserve cervical ROM, and reduce the incidence of postoperative AS. TRIAL REGISTRATION: PROSPERO registration number is CRD42021230798. Date of registration: February 11, 2021.