No abstract

Background During open-door laminoplasty, the position of the bone gutter is not fixed, and when the gutter migrates inward, the outer end of the titanium plate must be fixed on the lamina edge. It is unclear whether this will affect the clinical efficacy. This study aimed to observe the influence of the titanium plate fixation position on the effectiveness of open-door laminoplasty for cervical spondylotic myelopathy (CSM). Methods A total of 98 patients with CSM who underwent open-door laminoplasty from August 2016 to October 2019 were included in this retrospective study. Fifty-five patients had the titanium plate fixed on the lateral mass (lateral mass group), and 43 patients had the titanium plate fixed on the lamina edge (lamina group). The opening angle, opening width, occurrence of hinge fracture, spinal cord drift distance, cervical curvature index (CCI), neurological function recovery (JOA score), neck function (NDI), C5 palsy and severity of axial symptoms were observed and compared between the two groups. Results The opening angle in the lamina group was significantly larger than that in the lateral mass group, while the opening width and the spinal cord drift distance were significantly smaller than those in the lateral mass group (P < 0.05). The occurrence of hinge fracture in the lamina group was significantly higher than that in the lateral group (25.6% and 9.1%, respectively) (P < 0.05). The CCI was maintained well in both groups (P > 0.05), and there was no significant difference between the groups (P > 0.05). After surgery, the JOA score significantly increased in both groups (P < 0.05), and the neurological recovery rates were similar between the two groups (62.6% vs. 64.5%). The NDI score significantly decreased in both groups (P < 0.05), but the lateral mass group recovered to a greater degree than the lamina group (P < 0.05). The occurrence of C5 palsy was 2.3% in the lamina group and 14.5% in the lateral mass group, and there was a significant difference between the groups (P < 0.05). Postoperative axial symptom severity was significantly worse in the lamina group than in the lateral mass group (P < 0.05). Conclusions In open-door laminoplasty, it is feasible to fix the titanium plate on the lateral mass or to the lamina due to the same neurological function recovery. However, fixing it to the lamina will increase the opening angle and decrease the opening width, making the hinge prone to fracture and increasing the severity of postoperative axial symptoms.

ObjectiveThis retrospective study aimed to investigate the clinical and radiographic outcomes of open-door laminoplasty with modified centerpiece mini-plate fixation and extensor attachment point reconstruction for treating cervical spondylotic myelopathy (CSM).MethodSixty-nine patients with CSM, who underwent C3-7 open-door laminoplasty in our hospital from January 2016 to May 2017, were divided into two groups: group A underwent surgery with a modified centerpiece titanium plate and group B underwent surgery with a conventional centerpiece titanium plate. Changes in cervical spinal angle (CSA), cervical range of motion (ROM), atrophy of posterior cervical muscles, and neurological function (Japanese Orthopaedic Association [JOA] score) and the occurrence of axial symptoms (AS) were compared between the groups.ResultThere were no significant differences in operative time, intra-operative blood loss, lamina open angle, and spinal cord drift distance between the groups. After the surgery, JOA score significantly increased (P < 0.05), neurological recovery rates were similar (62.7% vs. 63.4%), cervical ROM did not significantly change when compared with the preoperative level (P > 0.05) in both groups; CSA and cross-sectional area of the posterior cervical muscles decreased significantly in group B (P < 0.05) but not in group A (P > 0.05), and postoperative AS were significantly more severe in group B than in group A (P < 0.05).ConclusionOpen-door laminoplasty is an effective surgical procedure for CSM. The application of modified centerpiece mini-plate fixation effectively reconstructs the posterior extensor attachment points, which reduces posterior cervical muscle atrophy, maintains cervical curvature, and reduces the occurrence of axial symptoms.