Does Facet Joint Violation Compromise Patient-Reported Outcomes and Motion Preservation Following Cervical Laminoplasty?

OBJECTIVE: In a cohort of patients undergoing cervical laminoplasty, determine the impact of facet joint violation on patient satisfaction, patient-reported outcome measures (PROMs), and preservation of range of motion (ROM).

SUMMARY OF BACKGROUND DATA: One technical concern of cervical laminoplasty is the potential violation of the facet joints during miniplate fixation, which may contribute to postoperative neck pain, reduced mobility, or accelerated degenerative changes. However, the clinical impact of facet joint violation in laminoplasty remains poorly defined.

METHODS: A single-institution retrospective cohort study was conducted of patients who underwent open-door laminoplasty with titanium miniplate fixation from 2018 to 2024. The primary independent variable was facet joint violation, defined as penetration of at least 1 miniscrew into the facet joint. Outcomes of interest included patient satisfaction using the North American Spine Society index; PROMs at 3 and 12 months, including a visual analog scale (VAS) for neck and arm pain and the neck disability index (NDI); and preservation of cervical ROM, expressed as a percentage of preoperative ROM, on flexion-extension radiographs.

RESULTS: Among the 82 patients included, the mean age was 59.3±10.7, and 38 (46.3%) were male. Facet joint violation was identified in 24 (29.3%) patients. There was no difference in 12-month patient satisfaction (88.2% vs. 89.5%, P=0.886), NDI (23.7±16.8 vs. 24.3±20.5, P=0.929), or VAS neck (2.7±2.7 vs. 3.2±2.9, P=0.593) and arm (2.9±3.1 vs. 3.0±3.1, P=0.972) pain between patients with and without facet joint violation. Similarly, there was no difference in postoperative ROM (30.4±15.4 vs. 28.9±10.9 degrees, P=0.699) or preservation of preoperative ROM (74.8±21.9 vs. 78.8±19.9%, P=0.546) between the cohorts.

CONCLUSIONS: Patient satisfaction, PROMs, and preservation of cervical ROM were comparable between patients with and without facet joint violation following cervical laminoplasty. These findings suggest that isolated facet joint violation may have a limited short-term clinical impact.

STUDY DESIGN: Retrospective cohort study.