Comparison of the Surgical Outcomes of Open-Door Laminoplasty, Double-Door Laminoplasty, and Selective Laminectomy for Degenerative Cervical Myelopathy

STUDY DESIGN: Multicenter, prospective cohort study. OBJECTIVE: To compare the clinical outcomes of three posterior decompression techniques-open-door (OD) laminoplasty, double-door (DD) laminoplasty, and selective laminectomy (SL)-in patients with degenerative cervical myelopathy (DCM). SUMMARY OF BACKGROUND DATA: Although OD, DD, and SL are widely used for DCM, prospective comparative studies evaluating all three techniques in a large-scale cohort remain limited. METHODS: This study included 759 patients with DCM (OD: n=214; DD: n=157; SL: n=388) who underwent posterior decompression without fusion across 10 high-volume institutions in Japan. Clinical outcomes were assessed at baseline and 2 years postoperatively using the cervical Japanese Orthopaedic Association (JOA) score, SF-36, visual analog scale (VAS), and JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ). Cervical alignment and range of motion (ROM) were evaluated radiographically. A general linear model and multivariable logistic regression were used to compare outcomes after adjusting for relevant confounders. RESULTS: All groups showed significant postoperative improvement in JOA scores exceeding the minimal clinically important difference (MCID), with no significant differences among the groups. Similar improvements were observed in SF-36, VAS, and JOACMEQ domains. SL demonstrated significantly better preservation of cervical ROM at two years compared with OD and DD. The incidence of perioperative complications did not significantly differ among the three techniques. CONCLUSION: OD, DD, and SL provided comparable neurological recovery, functional improvement, and pain relief in patients with DCM. Although SL demonstrated superior preservation of cervical mobility, all three techniques were similarly safe and effective. Therefore, the choice of surgical procedure should be guided by the surgeon's experience, institutional protocols, and the clinical characteristics of each case.