Influence of Hinge Position on the Effectiveness of Expansive Open-door Laminoplasty for Cervical Spondylotic Myelopathy

Xia, Yingpeng; Xia, Yingyi; Shen, Qingshan; Li, Huinan; Xu, Tao

doi:10.1097/bsd.0b013e3182064632

Cited by 18 publications

(15 citation statements)

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“…73,74 The hinge position determines how open the door is and an inward shift of the hinge restricts excessive backward shift and overstretching of the nerve roots. 71 Although no patients in the narrow-group experienced C-5 palsy and 3 cases were seen in the wide group, this difference did not reach statistical significance. However, there was a lower incidence of this complication following laminoplasty with concurrent foraminotomy, suggesting that another potential cause of C-5 palsy is existing C-4/C-5 foraminal stenosis.…”

Section: Discussionmentioning

confidence: 76%

“…57 Similarly, hinge position (wide group: hinge located at the inner margin of the lateral mass; narrow group: hinge at the lamina margin) was not associated with the development of C-5 palsy (p = 0.17). 71 In a comparative study between open-door and doubledoor laminoplasty, C-5 palsy rates tended to be higher following open-door laminoplasty (p < 0.05). 34 Selective expansive open-door laminoplasty (EOLP) was designed to reduce damage to cervical posterior elements and prevent common long-term problems of laminoplasty, such as axial symptoms, malalignment, and decreased range of motion.…”

Section: Laminoplasty Techniquesmentioning

confidence: 99%

“…47,63 In addition, 11 studies compared laminoplasty techniques or considered technical differences such as laminoplasty with and without foraminotomy or muscle preservation. 28,29,34,38,39,43,57,58,60,66,71 …”

Section: Study Characteristicsmentioning

confidence: 99%

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A systematic review of clinical and surgical predictors of complications following surgery for degenerative cervical myelopathy

Tetreault

Ibrahim

Côté

et al. 2016

SPI

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OBJECT Although generally safe and effective, surgery for the treatment of cervical spondylotic myelopathy (CSM) is associated with complications in 11%–38% of patients. Several predictors of postoperative complications have been proposed but few are used to detect high-risk patients. A standard approach to identifying “at-risk” patients would improve surgeons’ ability to prevent and manage these complications. The authors aimed to compare the complication rates between various surgical procedures used to treat CSM and to identify patient-specific, clinical, imaging, and surgical predictors of complications. METHODS The authors conducted a systematic review of the literature and searched MEDLINE, MEDLINE in Process, EMBASE, and Cochrane Central Register of Controlled Trials from 1948 to September 2013. Cohort studies designed to evaluate predictors of complications and intervention studies conducted to compare different surgical approaches were included. Each article was critically appraised independently by 2 reviewers, and the evidence was synthesized according to the principles outlined by the Grading of Recommendation Assessment, Development and Evaluation (GRADE) Working Group. RESULTS A total of 5472 citations were retrieved. Of those, 60 studies met the inclusion criteria and were included in the review. These studies included 36 prognostic cohort studies and 28 comparative intervention studies. High evidence suggests that older patients are at a greater risk of perioperative complications. Based on low evidence, other clinical factors such as body mass index, smoking status, duration of symptoms, and baseline severity score, are not predictive of complications. With respect to surgical factors, low to moderate evidence suggests that estimated blood loss, surgical approach, and number of levels do not affect rates of complications. A longer operative duration (moderate evidence), however, is predictive of perioperative complications and a 2-stage surgery is related to an increased risk of major complications (high evidence). In terms of surgical techniques, higher rates of neck pain were found in patients undergoing laminoplasty compared with anterior spinal fusion (moderate evidence). In addition, with respect to laminoplasty techniques, there was a lower incidence of C-5 palsy in laminoplasty with concurrent foraminotomy compared with nonforaminotomy (low evidence). CONCLUSIONS The current review suggests that older patients are at a higher risk of perioperative complications. A longer operative duration and a 2-stage surgery both reflect increased case complexity and can indirectly predict perioperative complications.

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Section: Discussionmentioning

confidence: 76%

Section: Laminoplasty Techniquesmentioning

confidence: 99%

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A systematic review of clinical and surgical predictors of complications following surgery for degenerative cervical myelopathy

Tetreault

Ibrahim

Côté

et al. 2016

SPI

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“…Xia et al [19] reported that in open-door laminoplasty, patients with a relative lateral through on the hinge side .were more susceptible to C5 palsy. Zhang et al [14] considered that the lamina open angle in laminoplasty should be maintained between 15°∼30°, or otherwise the risk of postoperative C5 palsy may increase.Radcliff et al [17] found a wider laminectomy at C5 and an increased diameter of the spinal canal were associated with an increased risk of C5 palsy.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Risk Factors of C5 Palsy following Posterior Cervical Decompression: A Systematic Review

Cao

Gao

et al. 2014

PLoS ONE

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BackgroundC5 palsy is a serious but poorly understood complication after posterior cervical decompression that could lead to muscle weakness, brachialgia and numbness of the upper limbs. The incidence of C5 palsy varies greatly between studies. The risk factors are inconclusive and even conflicting.ObjectTo perform a systematic review on the incidence and risk factors of C5 palsy after posterior cervical decompression.Materials and MethodsFour databases, PubMed, Embase, Web of Science and Cochrane CENTRAL, were searched to identify eligible studies. Either a fixed- or a random-effects model was used to calculate the pooled odd ratio (RR) or standardized mean difference (SMD) with its 95% confidence interval (95%CI).ResultsOf the 589 pre-recruited studies, 25 were included in this study for systematic review. The pooled incidence of C5 palsy after posterior decompression was 5.8% (95%CI: 4.4–7.2%). The incidence after open-door laminoplasty, double-door laminoplasty and laminectomy was 4.5%, 3.1% and 11.3%, respectively. The significant risk factors of C5 palsy were OPLL (OR, 2.188; 95%CI, 1.307–3.665), narrower intervertebral foramen (SMD, −0.972; 95%CI, −1.398 to −0.545), laminectomy (vs. open-door laminoplasty, OR, 2.988; 95%CI, 1.298–6.876), excessive spinal cord drift (SMD, 1.289, 95%CI, 0,197–2.381) and male gender (OR, 1.54; 95%CI, 1.036–2.301).ConclusionsThe results of this systematic review suggest that patients with excessive spinal cord drift, preexisting intervertebral foramenal stenosis, OPLL, laminectomy and male gender are at high risk for postoperative C5 palsy, and risk-reduction options should be considered for such patients.

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“…[1][2][3][4][5] Despite presumed advantages, open-door laminoplasty is not uniformly accepted compared with laminectomy and fusion due to several drawbacks, including reclosure problems, hinge fracture, and potential injuries to the nerve roots or the spinal cord by bone grafts at the open side. [6][7][8][9] Controversy over laminoplasty still exists. Some recent studies reported good outcomes with plate-only open-door laminoplasty in patients with cervical spinal canal stenosis in which mini-plates were used to reconstruct the spinal canal.…”

mentioning

confidence: 99%

Modified Plate-only Open-door Laminoplasty Versus Laminectomy and Fusion for the Treatment of Cervical Stenotic Myelopathy

Yang

Gu²,

Shi³

et al. 2013

Orthopedics

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The purpose of this study was to compare modified plate-only laminoplasty and laminectomy and fusion to confirm which of the 2 surgical modalities could achieve a better decompression outcome and whether a significant difference was found in postoperative complications. Clinical data were retrospectively reviewed for 141 patients with cervical stenotic myelopathy who underwent plate-only laminoplasty and laminectomy and fusion between November 2007 and June 2010. The extent of decompression was assessed by measuring the cross-sectional area of the dural sac and the distance of spinal cord drift at the 3 most narrowed levels on T2-weighted magnetic resonance imaging. Clinical outcomes and complications were also recorded and compared. Significant enlargement of the dural sac area and spinal cord drift was achieved and well maintained in both groups, but the extent of decompression was greater in patients who underwent laminectomy and fusion; however, a greater decompression did not seem to produce a better clinical outcome. No significant difference was observed in Japanese Orthopaedic Association and Nurick scores between the 2 groups. Patients who underwent plate-only laminoplasty showed a better improvement in Neck Dysfunction Index and visual analog scale scores. In addition, limited decompression, rigid reconstruction of the spinal canal, and preservation of cervical mobility combined with preservation of the posterior structure resulted in a lower rate of postoperative C5 palsy and axial pain in the modified laminoplasty group. For this reason, modified laminoplasty may be a more viable option for patients with cervical stenotic myelopathy.

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Influence of Hinge Position on the Effectiveness of Expansive Open-door Laminoplasty for Cervical Spondylotic Myelopathy

Cited by 18 publications

References 0 publications

A systematic review of clinical and surgical predictors of complications following surgery for degenerative cervical myelopathy

A systematic review of clinical and surgical predictors of complications following surgery for degenerative cervical myelopathy

Incidence and Risk Factors of C5 Palsy following Posterior Cervical Decompression: A Systematic Review

Modified Plate-only Open-door Laminoplasty Versus Laminectomy and Fusion for the Treatment of Cervical Stenotic Myelopathy

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