Objective:Although the lamina open angle of making hinges is closely related to the outcomes of French-door laminoplasty (FDL) for treatment of cervical spondylosis, there have been no methods to predict the lamina open angle preoperatively as yet. The aim of this study was to investigate the accuracy of predicting the laminal open angle using our newly designed sharp rongeur, and to compare the postoperative outcomes and complications between the methods of making hinges using the newly designed sharp rongeur and the traditional high-speed micro-drill during the FDL.Methods: This was a single-center retrospective study. Following the approval of the institutional ethics committee, a total of 39 patients (Male: 28; Female: 11) diagnosed with cervical spondylos who underwent FDL in our institution between January 2018 and May 2019 were enrolled. Patients were divided into two groups based on the method of making hinges (sharp rongeur: 22 cases; high-speed micro-drill: 17 cases). The average age at surgery was 59.1 years (range: 16-85 years). The radiological parameters, clinical outcomes, modified Japanese Orthopaedic Association (mJOA) scale score, and the recovery rate of mJOA were recorded and compared between the groups, respectively. The radiological parameters and clinical measurements at pre-and post-operation stages were compared using the paired-sample t-test, the Wilcoxon signed-rank test, and the Friedman's test, and variables in the two groups were analyzed using an unpaired Student's t-test or a Mann-Whitney U test. Results:The average follow-up period was 20.4 months (range: 14.0-25.9 months), the postoperative open angle was 60.13 AE 3.69 in the rongeur group with 22.78 AE 4.34 of angular enlargement, which was significantly lower than that of 68.96 AE 1.00 in the micro-drill group with 32.75 AE 4.22 of angular enlargement (U = 19.000, p < 0.001). The rongeur group showed a higher fusion rate (34.1% vs 14.7%, χ 2 = 11.340, p = 0.001), and a lower fracture rate of the lamina (7.8% vs 25.5%, χ 2 = 14.185, p < 0.001) at 1-month post-surgery, compared to the microdrill group. There were no significant differences in the clinical outcomes and postoperative complications between the two groups (p > 0.05), except in the recovery rate of mJOA scores (0.836 AE 0.138 vs 0.724 AE 0.180, U = 115.000, p = 0.042) and neck disability index (NDI) at the final follow-up (7.55 AE 10.65 vs 14.71 AE 8.72, U = 94.000, p = 0.008). Conclusions:The special sharp rongeur with a tip angle of 20 could be a preferred method to make hinges during FDL, which can predict the laminal open angle accurately and enlarge it to about 23 , thus reducing the fracture rate and accelerating the bony fusion of hinges compared with the outcomes of the traditional micro-drill method.
Background. To evaluate the long•term clinical outcomes of Magerl's technique combined with single laminar clamp internal fixation in treatment of reducible atlantoaxial dislocation. Methods. Data of 21 patients diagnosed with reducible atlantoaxial dislocation underwent Magerl's technique(C1-2 posterior transarticular screw fixation) combined with single laminar clamp internal fixation and fusion were retrospectively reviewed from January 2004 to September 2015.The clinical and radiological outcomes were investigated according to the Symonand Lavender clinical standard, the score of Japanese Orthopaedic Association (JOA), and the imaging index space available for the cord (SAC), the atlas•dens interval (ADI), respectively. The perioperative complications, operative data, and status of bony fusion were also collected and analyzed. Results. All the patients were followed up successfully.All the patients achieved substantially bone fusion according to the X-ray and CT scan. There were no intra-operative complications observed. The ADI was corrected significantly with the mean preoperative 6.13±1.84 mm, initial postoperative 1.62±0.77 mm, and the final follow-up 2.02±1.01 mm respectively(P<0.05).The SAC was also improved significantly with the mean preoperative 10.42±2.53 mm, initial postoperative 17.83±2.41 mm, and the final follow-up 16.91±2.02 mm respectively (P<0.05).The clinical recovery rate according to the Symonand Lavender clinical standard and the JOA recovery rate was 90.5% and 81.2% respectively, which showed significantly improved following surgery (P<0.05). Conclusions. This study demonstrates that Magerl's technique combined with single laminar clamp internal fixation is effective and reliable in management of reducible atlantoaxial dislocation, which can simplify the operative manipulation and decrease the risk of iatrogenic spinal cord injury.
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