Efficacy and Safety of C3 Laminectomy Combined with Open-Door Laminoplasty versus Open-Door Laminoplasty Alone: A Systematic Review and Meta-Analysis.

Background: To evaluate efficacy and safety between C3 laminectomy + open-door laminoplasty and open-door laminoplasty alone.

Methods: Electronic databases were systematically searched up to January 2024. Review Manager 5.4 was applied to manage the data and perform the review. Cochrane Library, PubMed, OVID, and Web of Science were searched for studies comparing C3 laminectomy + open-door laminoplasty and open-door laminoplasty alone. Forest plots were constructed for each analysis group.

Results: After selection, 9 eligible articles included 10 comparison groups, with a combined 320 patients who underwent C3 laminectomy + open-door laminoplasty and 355 who underwent open-door laminoplasty alone. There was no difference in operative time, blood volume, Japanese Orthopaedic Association score, Japanese Orthopaedic Association recovery score, visual analog scale score, Neck Disability Index, complications, axial symptoms, T1 slope, range of motion, and cervical sagittal vertical axis. C3 laminectomy + open-door laminoplasty was superior in C2-C7 Cobb angle.

Conclusions: Although C3 laminectomy + open-door laminoplasty has theoretic advantages, meta-analysis results show that the 2 surgical procedures are similar in terms of clinical symptoms improvement, sagittal balance, and complications. C3 laminectomy combined + open-door laminoplasty is superior only in the preservation of cervical lordosis. The limited number of studies may affect the reliability and generalizability of the results. Future high-quality, multicenter randomized controlled trials are needed to verify efficacy and safety.