Comparison of Axial Symptoms and Limitations of Activities of Daily Living Accompanying Reduced Neck Mobility After Cervical Laminoplasty Preserving C2 Muscle Attachments With and Without C2 to T1 Instrumented Fusion

Muscles are usually detached from C2 to facilitate C2 pedicle screw insertion. The aim of this study was to compare postoperative axial symptoms and limitations in activities of daily living (ADLs) accompanying reduced neck mobility between two procedures in which all C2 muscle attachments are preserved: laminoplasty and C2 to T1 fusion (LPF group: n = 15) and laminoplasty alone (LP group, n = 26), 1 year after surgery. We examined axial symptoms and limitations in ADLs using the Japanese Orthopedic Association Cervical Myelopathy Evaluation Questionnaire. We also examined related factors, including occiput (O)-C7 angle in extension and flexion, and rotation and O-C2 ranges of motion (ROMs). Postoperative decreases in O-C7 angle in flexion (27.8 degrees vs. 9.4 degrees) and rotational ROM (40 degrees vs. 15 degrees), and the compensating postoperative increase in O-C2 ROM (11.7 degrees vs. 2.3 degrees) were significantly greater in the LPF group. Most of the axial symptoms were similar between groups. Ability to perform ADLs tended to worsen more frequently in the LPF group, but the difference did not achieve significance. Postoperative changes in axial symptoms and the losses of ROM before affecting were not obstacles to performing ADLs after laminoplasty with muscle-sparing C2 to T1 fusion.