In this systematic review and meta-analysis, we aim to thoroughly describe and objectively compare the efficacy of anterior cervical plate (ACP) and stand-alone cage (SAC). Although recognized as an effective procedure for cervical degenerative disease (CDD), a debate between the methods of anterior cervical discectomy and fusion exists. ACP provides stability to the fusion construct; however, some complications have been reported, such as dysphagia, adjacent disc disease, and soft tissue injury. To overcome these complications, a SAC was later introduced. A systematic search was conducted on the basis of PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines to identify relevant studies through PubMed, Google Scholar, and Cochrane database. A total of 14 studies (960 patients) were included in the meta-analysis. Twenty outcomes were clinically and radiologically compared between the two procedures. ACP and SAC were comparable in terms of dysphasia rate, loss of segmental angle, loss of disc height, the Odom criteria, Robinson's criteria, hospital stay, Japanese Orthopaedic Association score, Neck Disability Index, Visual Analog Scale, and fusion time. However, SAC was superior in terms of shorter operation time, less blood loss, lower dysphagia rate, and lower rate of adjacent level disease, whereas ACP was advantageous in terms of lower subsidence rate, better maintenance of the cervical global and segmental angles and disc height, and higher fusion rate. Both procedures can be used in patients with CDD, although it might be more beneficial to choose ACP in patients with multi-level pathologies, wherein better mechanical stability is provided. However, SAC may be more beneficial to use in patients with comorbidities, anemia, or swelling problems because it offers lower complication rates.

BACKGROUND: At present, few reports are comparing these 2 major cervical posterior laminoplasty methods with Open-door and French-door Laminoplasty in terms of neurological recovery, cervical alignment, and surgical complications. Moreover, most of the research has not been well designed. AIM: This study aims to determine comparative effectiveness and functional outcome of open-door versus french-door laminoplasty for multilevel cervical myelopathy. METHODS: The Meta-analysis is used in this study. The study sample is a published research articles on comparative effectiveness and functional outcome of open-door versus french-door laminoplasty for multilevel cervical myelopathy on the internet through databases on PubMed and ProQuest and published between 1997 until December 2018. Weighted mean difference and pooled weighted mean difference are calculated by using the fixed-effect model or random-effect model. Data is processed by using Review Manager 5.3 (RevMan 5.3). RESULTS: This study reviews 58 articles. There are 6 studies conducted a systematic review and continued with Meta-analysis of relevant data. The results showed significant higher postoperative Japanese Orthopaedic Association (JOA) score in open-door laminoplasty (ODL) than French-door laminoplasty (FDL) (weighted mean difference [WMD] = 0.71; 95% confidence interval [CI]: 0.35 to 1.07; p < 0.05). The outcome of procedures treatment of multilevel cervical myelopathy revealed the operative time, cervical range of motion, axial canal diameter postoperative, axial pain reduction and complications events in ODL and FDL there was no significant difference. But for a cervical lordotic angle in ODL and FDL, there was a significant difference; the ODL group were significantly lesser than the FDL group. The recovery rate in ODL and FDL, there was a significant difference; the ODL was shown to be significantly higher than FDL (p < 0.05). CONCLUSION: This analysis suggests that neither cervical laminoplasty approach is superior, based on the postoperative radiological data and complication rate. But the open-door laminoplasty resulted in a higher functional outcome and recovery rate as compared to the French-door laminoplasty.

Infectious spondylitis is estimated to affect 4-24 patients per million per year, with male:female ratio of 1.5:2.1. Contributing to 0.15%-5% of all osteomyelitis cases, until date, the treatment of infectious spondylitis is still very challenging in order to minimalize the mortality and morbidity of these patients [1,2].Surgical intervention is needed in patients unresponsive to antibiotic treatments, those with spinal instability, neurological deficit, soft tissue abscess involvement, and significant spinal destruction. In order to ensure infection eradication, open sur-

Introduction Traditional bone setter's gangrene is a devastating complication arising from the practice of TBS with a prevalence of 4.29%, and most cases require amputation, which led to permanent disability. This case demonstrates a catastrophic presentation of the lower limb gangrene secondary to traditional bone setter's treatment. Case presentation A 39-year-old man with history of treatment by traditional bone setter presented with generalized pain with loss of the skin throughout the entire right lower leg, leaving soft and hard tissue exposed to the environment. His vital signs showed tachycardia and fever. Pulses were absent on the entire lower leg except for the femoral artery. The radiograph revealed gas density around the soft tissue suggestive of gas gangrene. After stabilization, an above-knee amputation was performed by the orthopedic surgeon. Discussion Traditional bone setter's gangrene is a significant contributor to amputations in many developing countries. The practice of scarification, massage with herbal concoctions and creams, and a tight splint may lead to infection, vascular compromise, compartment syndrome that may terminate in gangrene or death of the limb. This progressive limb-threatening infection emphasizing the importance of early recognition of compartment syndrome, adequate resuscitation or stabilization, and prompt and aggressive treatment. Conclusion This case highlights the menace of TBS activities and the dangers inherent in their practice. People who are misguided by false beliefs should be educated by public enlightenment. Appropriate legislation should be supplemented by the government to integrate traditional bone settings with the new orthopedic care services.