Abstract

Introduction: Laminoplasty is indicated in patients with cervical spondylotic myelopathy
(CSM) who have multilevel cervical spinal cord compression and a neutral or lordotic
cervical spine alignment. However, axial neck pain is a common complication post-surgery,
which may be caused by surgical damage to the semispinalis cervicis (SSC) muscle
attachment on the C2 spinous process. Modified C4-C7 laminoplasty with C3 laminectomy
completely preserves the SSC insertion on C2 and reduces the incidence of axial neck pain at
subsequent follow-ups.
Aim: Our study aims to evaluate the clinical and radiological outcome of C4-C7 laminoplasty
with C3 laminectomy for CSM in the Indian population.
Materials and Methods: We performed a retrospective analysis of 21 patients who
underwent the surgery for CSM with a minimum one-year follow-up. Clinical improvement
is measured using the modified Japanese Orthopedic Association (MJOA) score and visual
analogue scale (VAS). Radiographic parameters evaluated were the C2-C7 lordosis angle and
the cervical range of motion (ROM).
Results: In our study, the mean age of the patients was 54±7.7 years, and follow-up period
was 20.5±4.6 months. At a one-year follow-up, the mean pre-operative MJOA score
improved from 9.5±1.9 to 14.9±1.1 (p<0.001). Pre-operative axial neck pain was present in
nine patients with a mean VAS score of 4.9±0.8, which improved to 3.7±0.7 (p<0.001) at
three-month follow-up. At the final follow-up, only four patients had axial neck pain with a
mean VAS score of 1.1±1.4.
Conclusion: C3 laminectomy with C4-C7 laminoplasty is a safe, effective technique, which
achieves good neurological improvement and reduces the incidence and severity of postoperative
axial neck pain in the Indian population