Posterior cervical laminectomy, fusion to C2 had equivalent outcomes vs. C3/4
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PHILADELPHIA — Results showed posterior cervical laminectomy and fusion instrumented to C2 had longer operative times, but equivalent patient-reported outcomes and complications, compared with patients instrumented to C3/4.
Hani Chanbour, MD, and colleagues collected activities of daily living, operative time, length of stay, complications and patient-reported outcomes among 117 patients who underwent elective posterior cervical laminectomy and fusion for degenerative pathology. Researchers categorized patients into two groups based on whether they had an upper instrumented vertebrae of C2 (n=39) or C3/4 (n=78) and propensity matched them for fusion extending to the thoracic spine.
“For the operative variable, compared to C3/4, the C2 group had more levels fused with similar fusion rate on CT, as well as similar [activities of daily living] and lengths of stay,” Chanbour said in his presentation at the American Association of Neurological Surgeons Annual Meeting.
Patients in the C2 group had longer operative times compared with the C3/4 group, according to Chanbour. Although the C3/4 group had more major complications, Chanbour noted the differences were not statistically significant. He added there were no statistical differences in overall surgical and mechanical complications between the two groups, despite more adjacent segment disease pathology found in the C3/4 group. Chanbour also noted the two groups had no differences in EuroQol-5D, neck disability index score and pain scores.
“In serving the second objective of our study, subanalysis was performed to compare pars, pedicle and laminar C2 screws. There was no difference in levels fused, [activities of daily living] and lengths of stay between the three groups,” Chanbour said. “However, operative time was the longest in the laminar screw, but it wasn’t statistically significant. This might be due to the time taken for rod bending in the laminar screw group, whereas pars screws are easier to do.”
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Chanbour H, et al. Is it better to stop at C2 or C3/C4 in elective posterior cervical decompression and fusion? Presented at: American Association of Neurological Surgeons Annual Meeting. April 29-May 2, 2022; Philadelphia.
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