Open-door servikal laminoplasti tekniğine bağlı hinge fraktürü (menteşe kırığı) komplikasyonu gelişmesini etkileyen risk faktörlerinin değerlendirilmesi

Abstract

Aim: Open-door cervical laminoplasty is the standard surgical option for patients with multipl levels cervical myelopathy. In this surgical technique, while linear laminectomy is performed on one side of the lamina, bone is drilled to form a hinge on the opposite side. Hinge fractures may occur on the other side while lifting the linear laminectomy side. Our study aimed to examine possible risk factors for preventing these fractures. Materials and Methods: The patients' files, radiological images, and laboratory results who underwent cervical laminoplasty between 2013-2018 were retrospectively analyzed. Results: A total of 78 patients, 54 males and 24 females, were included in the study. The mean age of the patients was 57.8±11.6 years. The mean modified Japanese Orthopedic Association (JOA) cervical myelopathy scores of the patients before the operation were 16.2±2.1. When the preoperative blood Ca values were examined, the mean value was 9.3±0.5 mg/dl. The mean Pavlov ratio of the patients was 0.7±0.2. Laminas were opened from the right side in 26 cases and from the left side in 52 cases. A total of 304 laminae were opened. In post-operative control cervical CTs, 42 patients had lamina hinge fractures, and the number of patients without hinge fracture was 36. There were 89 fractures in total at the lamina level. When post-operative cervical tomography images were examined, the mean opening angle (OA) of the laminas was 30.6±8.9 degrees. The opening angle of the lamina was determined to affect the hinge fracture significantly. While OA was 32.3±9 degrees in patients with lamina hinge fracture, it was found to be 28.7±8.3 in patients without fractures (p <0.05). Conclusion:During open-door cervical laminoplasty, the excessive opening angle of the lamina increases the possibility of hinge fractures. Pre-operative necessary measurements will reduce the risk of hinge fractures during surgery. This evaluation will reduce the risk of complications during the operation and increase patient comfort in the post-operative period.