Abstract
BACKGROUND: Laminoplasty complications, particularly axial symptoms and C5 nerve root palsy, significantly impair patients' quality of life. To address these challenges, we used a modified surgical technique that preserves muscular attachments to the C3 and C7 spinous processes while incorporating C4/C5 foraminotomy, aiming to reduce the incidence of these complications. METHODS: A retrospective analysis was conducted on 93 patients who underwent laminoplasty for cervical spondylotic myelopathy (CSM) at our institution between January 2016 and June 2022. The cohort comprised 42 patients receiving modified laminoplasty (modified group) and 51 patients undergoing traditional laminoplasty (traditional group). Demographic and surgical parameters, including gender, age, operative duration, intraoperative blood loss, postoperative hospital stay, and complications, were systematically collected. Radiographic parameters including C0-C2 Cobb angle, C2-C7 Cobb angle, T1 slope (T1S), and C2-C7 sagittal vertical axis (SVA) were measured preoperatively and at follow-up on X-ray films. Functional outcomes were evaluated using Japanese Orthopaedic Association (JOA) and Neck Disability Index (NDI) scores. RESULTS: The mean follow-up duration was 55.2 months. No significant differences were observed in terms of gender, age, or operation time between the two groups. Modified group exhibited significantly lower intraoperative blood loss and shorter postoperative hospital stays compared to traditional group (p = 0.013 and p = 0.024, respectively). At follow-up, the C2-C7 Cobb angle and C2-C7 SVA in the modified group, as well as the C2-C7 Cobb angle in the traditional group, demonstrated significant reductions (17.02 ± 10.49° vs. 20.76 ± 10.55°; 24.00 ± 9.18 mm vs. 26.81 ± 9.22 mm; 14.94 ± 12.31° vs. 23.04 ± 10.58°, p < 0.05). Furthermore, the decrease in the C2-C7 Cobb Angle was more pronounced in the traditional group compared to the modified group (-8.10 ± 9.24° vs. -3.74 ± 8.52°, p < 0.05). The NDI score improved more significantly in the modified group than in the traditional group (-13.90 ± 7.59 vs. -10.16 ± 8.74, P = 0.032), whereas the improvement in the JOA score was similar between the two groups (p = 0.344). Additionally, the increase in the postoperative NDI score was positively correlated with increases in T1S and C2-C7 SVA (r = 0.181, p < 0.05; r = 0.208, p < 0.01). CONCLUSION: Compared with traditional laminoplasty, the modified laminoplasty provided equivalent neurological decompression efficacy while demonstrating superior clinical advantages, including reduced surgical invasiveness, preserved cervical stability, and a lower incidence of postoperative axial symptoms, though it showed no significant difference in preventing postoperative C5 palsy.