Mini-plate fixation versus suture suspensory fixation in cervical laminoplasty

Abstract

Background:Both the mini-plate fixation and suture suspensory fixation techniques are extensively applied in cervical laminoplasty, but which technique is superior has not been ascertained. The purpose of this meta-analysis is to compare the results between mini-plate fixation and suture suspensory fixation in cervical laminoplasty for the patients with multilevel cervical compressive myelopathy.Methods:PubMed, Embase, the Cochrane library, CNKI, and WANFANG were searched for studies that compared mini-plate fixation and suture suspensory fixation in cervical laminoplasty up to November 1, 2016. We calculated odds ratio (OR) with 95% confidence interval (CI) for dichotomous outcomes and mean difference (MD) with 95% CI for continuous outcomes. Review Manager 5.3 was used for the statistical analyses.Results:A total of 25 studies, involving 1603 participants, were included in this review. The results of this meta-analysis indicated that there were statistically significant differences in postoperative Japanese Orthopedic Association (JOA) scores (MD = 0.67, 95% CI: 0.34–0.99, P < 0.001), JOA scores improvement rate (MD = 4.00, 95% CI: 2.51–5.50, P < 0.001), postoperative Visual Analogue Score (VAS) (MD = −0.81, 95% CI: −1.36 to −0.26, P = 0.004), postoperative range of motion (ROM) (MD = 4.15, 95% CI: 2.06–6.23, P < 0.001), postoperative cervical lordosis (MD = 3.1, 95% CI: 2.02–4.18, P < 0.001), postoperative anteroposterior diameter of the spinal canal (MD = 1.53, 95% CI: 0.11–2.95, P = 0.03), postoperative open angle (MD = 1.93, 95% CI: 0.14–3.71, P = 0.03), postoperative cross-sectional area of the spinal canal (MD = 37.10, 95% CI: 26.92–47.29, P < 0.001), axial symptoms (OR = 0.28, 95% CI: 0.20–0.37, P < 0.001), operation time (MD = 4.46, 95% CI: 0.74–8.19, P = 0.02), and blood loss (MD = 9.24, 95% CI: 6.86–11.62, P < 0.001). However, there was no statistically significant difference in C5 palsy (OR = 0.82, 95% CI: 0.37–1.84, P = 0.63).Conclusions:As compared with suture suspensory fixation, mini-plate fixation in cervical laminoplasty appears to achieve better clinical and radiographic outcomes with fewer surgical complications. However, mini-plate fixation is associated with bigger surgical trauma. This conclusion should be interpreted cautiously and more high-quality, randomized controlled trials are needed in the future.

The impact of plating level on the postoperative loss of cervical lordosis in alternative skipped-level plating laminoplasty

“…The costeffectiveness benefits of routinely using plates in laminoplasty are still debatable. 3,24 Recently, skipped-level plating has been reported to be an effective cost-saving strategy for laminoplasty surgery. [9][10][11][12] Cheung et al reported a cohort study comparing the outcomes between skipped-level and full-level plating for laminoplasty with an average follow-up of 5 years, they found that skipped-level and all-level plating for open-door laminoplasty yielded similar clinical and radiological outcomes.…”

Comparable clinical and radiological outcomes between skipped-level and all-level plating for open-door laminoplasty

“…[5][6][7] However, increased laminar closure or spring-back has been reported with this technique. [8,9] Spring-back phenomenon or closure, has a reported rate of 10% [9] depending on its definition, and is a major concern in laminoplasty as closure of the laminae opening can lead to renarrowing of the spinal canal and recurrence of symptoms. Since then, mini-plates have been used as a more rigid fixation alternative to maintain the laminae opening.…”

“…Since then, mini-plates have been used as a more rigid fixation alternative to maintain the laminae opening. [10,11] Despite apparent clinical benefits [8], mini-plates are costlier. As healthcare providers, this increased cost is a factor that should be considered when designing a management strategy.…”

Comparison of anchor screw fixation versus mini-plate fixation in unilateral expansive open-door laminoplasty for the treatment of multi-level cervical spondylotic myelopathy

“…[3] Mini-plate fixation has been considered better than traditional facet joint suturing technique based on published data. [4,5] Currently, both the mini-plate fixation and anchor screw fixation techniques are widely applied in laminoplasty for treating MCSM, but the scientific support is weak as for which technique is superior.…”