Comparison of long-term clinical and radiographic outcomes between alternative-level and all-level fixation unilateral open-door laminoplasty

Zhang, Zhuang; Wang, Lin-nan; Song, Yueming; Wang, Lei; Líu, Hao; Liu, Limin; Peng, Xiaoyan; Zhou, Zhongjie

doi:10.1016/j.spinee.2020.06.018

Cited by 5 publications

(16 citation statements)

References 27 publications

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“…Unfortunately, a high rate of nonunion of cervical discectomy and fusion (17%–45%) has been found due to multi‐level bone graft 27 . In parallel, posterior laminectomy or laminoplasty is a usual treatment option for multi‐level cervical spinal stenosis involving more than three segments 28–33 . Posterior laminectomy is also widely used for spinal cord decompression in patients with multi‐level cervical spinal stenosis.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Open‐Door Laminoplasty Combined with Bilateral Lateral Mass Screw Fixation for Multi‐Level Cervical Spinal Stenosis with Traumatic Cervical Instability and Spinal Cord Injury: A Retrospective Study

Liu

et al. 2023

Orthopaedic Surgery

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Objectives:The prevalence of multi-level cervical spinal stenosis complicated with traumatic cervical instability and spinal cord injury (MCSS-TCISCI) is low, and the optimal surgical approach remains unclear. Open-door laminoplasty combined with bilateral lateral mass screw fixation (ODL-BLMSF) is a relatively new surgical technique; however, its clinical effectiveness in managing MCSS-TCISCI has not been well-established. This study aims to assess the clinical value of ODL-BLMSF against MCSS-TCISCI. Methods:We retrospectively analyzed 20 cases of MCSS-TCISCI treated with ODL-BLMSF from July 2016 to June 2020. Radiographic alterations of all included patients were measured using plain radiographs, CT scans, and MRI scans. Cervical lordosis was evaluated using C2-C7 Cobb angle and cervical curvature index (CCI) on lateral radiographs, and Pavlov ratio at the C5 level. Neurological functional recovery was assessed using Japanese Orthopaedic Association (JOA) scores and Nurick grade, while neck and axial symptoms were assessed using the neck disability index (NDI) and the visual analog scale (VAS). The paired t-test was utilized for statistical analysis.Results: All included patients were followed up for an average period of 26.5 months (range: 24-30 months) after ODL-BLMSF. The average Pavlov ratio at the C5 level significantly improved from 0.57 AE 0.1 preoperatively to 1.13 AE 0.1 and 1.12 AE 0.04 at 6 months postoperatively and at the last follow-up (t = 16.347, 16.536, p < 0.001). Importantly, this approach significantly increased the JOA score from 5.0 AE 2.6 before surgery to 11.65 AE 4.3 and 12.1 AE 4.3 at 6 months postoperatively and at the last follow-up (t = 9.6, À9.600, p < 0.001), with an average JOA recovery rate of 59.1%; and the average Nurick disability score decreased from 3.0 AE 1.3 (preoperative) to 1.65 AE 1.22 and 1.5 AE 1.2 (6 months postoperatively and at last follow-up) (t = 5.111, 1.831, p < 0.001). Meanwhile, the NDI score decreased from 30.3 AE 4.3 preoperatively to 13.2 AE 9.2 at 6 months (t = 12.305, p < 0.001), and to 12.45 AE 8.6 at the final follow-up (t = 13.968, p < 0.001), while the VAS score decreased from 4.0 AE 1.5 preoperatively to 1.5 AE 0.7 at 6 months (t = 9.575, p < 0.001), and to 1.15 AE 0.7 at the final follow-up (t = 10.356, p < 0.001). Conclusion:ODL-BLMSF can effectively dilate the stenotic spinal canal to decompress the spinal cord, maintain good cervical alignment and stability, and improve the recovery of neurological function and neck function. This technique is suitable for treating selected cases of MCSS-TCISCI.

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Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Open‐Door Laminoplasty Combined with Bilateral Lateral Mass Screw Fixation for Multi‐Level Cervical Spinal Stenosis with Traumatic Cervical Instability and Spinal Cord Injury: A Retrospective Study

Liu

et al. 2023

Orthopaedic Surgery

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“…In many long-term follow-up studies over the past 2 decades, open-door laminoplasty has been proven to be an effective and simple surgical procedure for the treatment of multilevel CSM [ 2 – 4 , 6 – 8 ]. With the continuous development and innovation of surgical internal fixation devices, the fixation method of lamina has also changed from the initial suture suspensory to an anchor, and mini-titanium plates are widely used at this stage [ 3 , 4 , 9 ]. Through a clinical meta-analysis, Mo et al [ 8 ] found that compared with suture suspensory and anchor fastening, mini-titanium plate fixation can reduce the loss of range of motion, and the incidence of axial symptoms and C5 palsy is reduced.…”

Section: Discussionmentioning

confidence: 99%

“…C 5 palsy is defined as a new occurrence of paralysis of the deltoid and/or biceps brachii after surgery, usually with mild myasthenia and C 5 dermatome sensation disturbances [ 5 ]. The Neck Disability Index (NDI) scoring system was used to assess the neck pain and neck function preoperatively and postoperatively [ 3 ].…”

Section: Methodsmentioning

confidence: 99%

“…Open-door laminoplasty is an effective surgical method for the treatment of CSM. With one side of the lamina as the axis and the other side as the door, it is opened to a certain angle to relieve spinal cord compression by increasing the volume of the spinal canal from the rear [ 1 – 3 ]. With the advantages of good surgical vision, simple steps, low surgical risk and simultaneous removal of multisegmental spinal cord compression, it has been widely carried out worldwide [ 2 – 4 ].…”

Section: Introductionmentioning

confidence: 99%

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Influence of fixed titanium plate position on the effectiveness of open-door laminoplasty for cervical spondylotic myelopathy

Liu

Ding

Chai³

et al. 2022

J Orthop Surg Res

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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.

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“…Moreover, although the outcome of laminoplasty for patients with K-line (+) C-OPLL is satisfactory [ 7 ], whether laminoplasty is appropriate for K-line (−) C-OPLL is unknown. Theoretically, the posterior shift of the spinal cord tends to be hindered in patients with thick ossification foci and/or kyphotic alignment [ 8 – 10 ]. However, few reports have focused on comparing the outcomes of the two laminoplasty techniques between patients with K-line (+) and (−) C-OPLL.…”

Section: Introductionmentioning

confidence: 99%

Are clinical outcomes affected by laminoplasty method and K-line in patients with cervical ossification of posterior longitudinal ligament? A multicenter study

Duan

et al. 2022

J Orthop Surg Res

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Background Open-door laminoplasty (ODL) and French-door laminoplasty (FDL) are the main laminoplasty techniques used to treat cervical ossification of the posterior longitudinal ligament (C-OPLL). However, few studies have compared the outcomes of ODL and modified FDL (mFDL) for C-OPLL. We explored the differences in outcomes between ODL and mFDL for C-OPLL and analyzed the technical efficacy of each procedure in patients with K-line (+) or (−) C-OPLL. Methods From January 2010 to December 2015, 202 patients with K-line (+) or (−) C-OPLL were retrospectively recruited from 4 institutions. Clinical outcomes were evaluated using the Japanese Orthopaedic Association (JOA) score, JOA score recovery rate, operative time, blood loss, and complications. Univariate analysis and binary logistic regression models were adjusted for confounding factors. Results Two hundred patients (mFDL, n = 69; ODL, n = 131) with a median follow-up of 42 months (range 36–54 months) were included. The postoperative JOA score significantly improved in both groups (P < 0.05). After adjusting for confounding factors, there was a statistically significant difference in blood loss (≥ 300 mL) between the two groups (P = 0.005), but there was no significant difference in the postoperative JOA score (≥ 14) (P = 0.062), JOA score recovery rate (≥ 0.82) (P = 0.187), or operative time (≥ 90 min) (P = 0.925). C5 palsy tended to occur more often in the mFDL group, although the difference was not significant (P > 0.05). The stratified analysis of the K-line status showed more blood loss in K-line (+) patients who underwent mFDL, but there was no significant difference in the postoperative JOA score, JOA score recovery rate, or operative time between the ODL and mFDL groups. Additionally, there was no significant difference in blood loss, postoperative JOA score, JOA score recovery rate, or operative time among all patients with K-line (+) or (−) C-OPLL in both groups. Conclusions Both ODL and mFDL are effective for patients with C-OPLL. However, more blood loss tends to occur during mFDL. This study showed no significant difference in the operative time or incidence of complications between the two techniques. The efficacy of ODL and mFDL was not affected by the K-line status (+ or −) in patients with C-OPLL.

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Comparison of long-term clinical and radiographic outcomes between alternative-level and all-level fixation unilateral open-door laminoplasty

Cited by 5 publications

References 27 publications

Clinical Outcomes of Open‐Door Laminoplasty Combined with Bilateral Lateral Mass Screw Fixation for Multi‐Level Cervical Spinal Stenosis with Traumatic Cervical Instability and Spinal Cord Injury: A Retrospective Study

Clinical Outcomes of Open‐Door Laminoplasty Combined with Bilateral Lateral Mass Screw Fixation for Multi‐Level Cervical Spinal Stenosis with Traumatic Cervical Instability and Spinal Cord Injury: A Retrospective Study

Influence of fixed titanium plate position on the effectiveness of open-door laminoplasty for cervical spondylotic myelopathy

Are clinical outcomes affected by laminoplasty method and K-line in patients with cervical ossification of posterior longitudinal ligament? A multicenter study

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