Comparative Effectiveness and Functional Outcome of Open-Door versus French-Door Laminoplasty for Multilevel Cervical Myelopathy: A Meta-Analysis

Wiguna, I Gusti Lanang Ngurah Agung Artha; Magetsari, Rahadyan; Noor, Zairin; Suyitno, Suyitno; Nindrea, Ricvan Dana

doi:10.3889/oamjms.2019.739

Cited by 12 publications

(4 citation statements)

References 13 publications

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“…Regarding cervical sagittal balance, there were no signi cant differences in C0-2 Cobb angle, C2-7 SVA, C2-7 Cobb angle, and T1-Slope between the two groups preoperatively. This may be because most patients in the observation group did not show obvious subluxation of the C2 vertebra in the lateral view, but instability was only evident in exion-extension views [29][30][31] . Therefore, there were no signi cant differences in these parameters between the two groups in the preoperative lateral X-rays.…”

Section: Discussionmentioning

confidence: 96%

The effects of C2 instability on cervical curvature changes and clinical outcomes after sub-axial cervical expansive door-open laminoplasty

Ma,

Meng,

et al. 2024

Preprint

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Objective: To investigate the impact of C2 vertebral instability on the sagittal parameters of the cervical spine and the clinical efficacy after cervical laminoplasty with unilateral open-door cervical expansive laminoplasty (EMOL). Methods: In a retrospective analysis of 18 patients with cervical 2 vertebral instability from August 2017 to August 2021 in the second Affiliated Hospital of Naval Military Medical University and the first Affiliated Hospital of Xinjiang Medical University treated with single open-door vertebroplasty (C3-6 or C3-7), 36 patients with stable cervical 2 cervical EMOL during the same period (control group). To evaluate the changes in sagittal parameters before and after surgery in the two groups, including C0-2 Cobb angle, C2-7 sagittal axis distance (sagittal vertical axis, SVA), C2-7 Cobb angle, T1 tilt angle (T1-Sl); The postoperative outcome was evaluated using the visual analogue score for neck and shoulder pain (visual analog scale, VAS) and the Japan Society Cervical Function Score (Japanese 0rthopaedic Association, JOA). Results: Compared to preoperative values, both the observation group and the control group showed significant improvement in postoperative VAS scores and JOA scores. The JOA scores were 14.0±1.6 and 13.1±1.6, with improvement rates of 68.42% and 58.06%, respectively, compared to their respective preoperative scores. However, there was no significant difference between the two groups. The observation group had significantly greater cervical range of motion (ROM) before surgery compared to the control group (p<0.05). At the last follow-up, the observation group showed a significant decrease in C2-7 Cobb angle from preoperative (8.2±0.1)° to (5.1±2.5)° (p<0.05). Cervical ROM decreased from preoperative (39.8±3.6)° to (31.6±4.5)° (p<0.05). C0-2 Cobb angle increased from preoperative (22.0±3.7)° to (25.8±3.1)° (p<0.05). C2-7 SVA increased from preoperative (-19.6±3.4)° to (-15.8±3.7)° (p<0.05). However, there was no significant change in T1 slope at the last follow-up (p>0.05). The observation group showed a decrease in C2 vertebral displacement from preoperative (4.5±0.9) mm to (3.3±0.5) mm (p<0.05), while the C2/3 angle showed no significant change compared to preoperative values (p>0.05). In both groups, postoperative follow-up showed a significant increase in C0-2 Cobb angle and C2-7 SVA, a non-significant difference in T1 slope, and a significant decrease in C2-7 Cobb angle and cervical ROM compared to preoperative values. However, there were no significant differences between the two groups in the above-mentioned parameters (p>0.05). Conclusion: C2 vertebral instability does not affect the sagittal parameters and efficacy of cervical laminoplasty with EMOL. EMOL surgery for cervical myelopathy with C2 vertebral instability is effective and reliable, without exacerbating C2 vertebral instability. Furthermore, it maintains good sagittal balance of the cervical spine.

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Section: Discussionmentioning

confidence: 96%

The effects of C2 instability on cervical curvature changes and clinical outcomes after sub-axial cervical expansive door-open laminoplasty

Ma,

Meng,

et al. 2024

Preprint

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“…French-door laminoplasty offers symmetrical decompression by opening the spinous processes' midline and hinging both laminae. Bilateral troughs are created on each lamina, thus creating a "French door" that allows the oat-back spinal cord to move posteriorly [25][26][27]. The spinal cord oats back, and enlargement can develop after surgery.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative ultrasound combined with MRI for evaluating float back and enlargement of the spinal cord after cervical laminoplasty in the management of degenerative cervical myelopathy

Li,

Chen,

Liu

et al. 2023

Preprint

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Background Spinal cord floating and enlargement can develop after cervical laminectomy and laminoplasty, it determines whether completely decompress the cord. To assess the relationship between immediate float back and enlargement of the spinal cord after decompression and subsequent recovery of spinal cord function. Methods The parameters associated with float back and enlargement of the spinal cord in Intraoperative ultrasound (IOUS) and preoperative MRI were investigated. Spinal cord function recovery was also investigated as measured by the mJOA score at the one-year follow-up. Results The average preoperative mJOA score was 10.24 ± 2.59, the postoperative mJOA score was 14.51 ± 2.32, and improvements in mJOA score were achieved with an average recovery rate of 64.29%±27.70%. The immediate float back distance after decompression (1.01 ± 0.49 mm) was positively correlated with the one-year follow-up mJOA score (P < 0.01, r = 0.68) and the recovery rate of the mJOA score (P < 0.01, r = 0.72). The immediate enlargement of the spinal cord (1.39 ± 0.84 mm) was positively correlated with the one-year follow-up mJOA score (P < 0.01, r = 0.64) and the recovery rate of the mJOA score (P < 0.01, r = 0.71). Immediate enlargement of the front side of the spinal cord (1.39 ± 0.59 mm) was positively correlated with the one-year follow-up mJOA score (P < 0.01, r = 0.74) and the recovery rate of the mJOA score (P < 0.01, r = 0.73). Interestingly, only enlargement of the front side of the spinal cord was positively correlated with the preoperative mJOA score (P < 0.05, r = 0.36). Conclusions The extent of immediate spinal cord float back, and enlargement after decompression in French-door cervical laminoplasty can be evaluated using preoperative MRI combined with IOUS, and these indications help predict the clinical outcome after French-door expansive laminoplasty.

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“…The anterior surgical procedure mainly includes anterior cervical discectomy and fusion (ACDF) ( 3 ), anterior cervical corpectomy and fusion (ACCF) ( 4 ), and cervical disk arthroplasty (CDA) ( 5 ); In contrast, laminectomy with or without instrumented fusion and open-door or French-door laminoplasty represent popular posterior surgical procedures ( 6 – 8 ). Due to concerns involved in multilevel surgical management, such as postoperative cervical deformity and segmental instability, ACDF and laminectomy with fusion (LF) are the commonly performed fusion surgeries for multilevel CSM, which are complemented by non-fusion open-door laminoplasty (LAMP), because certain reports indicate that LAMP results in a higher magnitude of function recovery and symptomatic alleviation than French-door laminoplasty (FDL) ( 9 ). Up to now, ACDF, LAMP, and LF have been the most commonly performed spinal surgical procedures for multilevel CSM because of their relatively low complication rates and fair neurological outcomes, whereas which among these three is the optimal procedure remains controversial.…”

Section: Introductionmentioning

confidence: 99%

Anterior cervical discectomy and fusion, open-door laminoplasty, or laminectomy with fusion: Which is the better treatment for four-level cervical spondylotic myelopathy?

Wen

Zhong²,

Xu³

et al. 2023

Front. Surg.

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Four-level cervical spondylotic myelopathy (CSM) is a common disease affecting a large number of people, with the optimal surgical strategy remaining controversial. This study compared the clinical outcomes, radiological parameters, and postoperative complications of primarily performed surgical procedures such as anterior cervical discectomy and fusion (ACDF), open-door laminoplasty (LAMP), and laminectomy with fusion (LF) in treating four-level CSM. A total of 116 patients who received ACDF (38 cases), LAMP (45 cases), and LF (33 cases) were followed up for a minimum of 24 months were enrolled in this study and retrospectively analyzed. Clinical outcomes were evaluated using the Japanese Orthopedic Association (JOA) scoring system, the Neck Disability Index (NDI), and the Visual Analogue Scale (VAS). Changes in the curvature of the cervical spine were determined using the cervical curvature index (CCI) and the C2–C7 Cobb angle. Cervical mobility was evaluated using the C2–C7 range of motion (ROM) and active cervical ROM (aROM). Complications were recorded and compared among the three groups. All patients achieved significant improvement in JOA, NDI, and VAS scores at the final follow-up (P < 0.05), whereas no remarkable difference was found among the groups (P > 0.05). In addition, both C2–7 ROM and aROM were significantly reduced in the three groups and LAMP showed the least reduction relatively. As for complications, LAMP showed the lowest overall incidence of postoperative complications, and patients in the ACDF group were more susceptible to dysphagia, pseudoarthrosis than LAMP and LF. Considering improvements in clinical symptoms and neurological function, no remarkable difference was found among the groups. Nevertheless, LAMP had advantages over the other two surgical procedures in terms of preserving cervical mobility and reducing postoperative complications.

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Comparative Effectiveness and Functional Outcome of Open-Door versus French-Door Laminoplasty for Multilevel Cervical Myelopathy: A Meta-Analysis

Cited by 12 publications

References 13 publications

The effects of C2 instability on cervical curvature changes and clinical outcomes after sub-axial cervical expansive door-open laminoplasty

The effects of C2 instability on cervical curvature changes and clinical outcomes after sub-axial cervical expansive door-open laminoplasty

Intraoperative ultrasound combined with MRI for evaluating float back and enlargement of the spinal cord after cervical laminoplasty in the management of degenerative cervical myelopathy

Anterior cervical discectomy and fusion, open-door laminoplasty, or laminectomy with fusion: Which is the better treatment for four-level cervical spondylotic myelopathy?

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