Posterior open-door laminoplasty secured with titanium miniplates vs anchors: a comparative study of clinical efficacy and cervical sagittal balance

Abstract

ObjectivePosterior open-door laminoplasty (PODL) is a common procedure for treating multilevel cervical spondylotic myelopathy (MCSM). Little information is available regarding the cervical sagittal balance and surgical efficacy of PODL when securing with different methods. Therefore, this study aims to investigate the clinical outcomes and the changes in cervical sagittal parameters and balance associated with PODL secured with titanium miniplates vs anchors.MethodA retrospective analysis was performed on the clinical data of 79 patients with MCSM who were treated in our institution from January 2015 to December 2016. Among them, 42 patients were treated by PODL secured with titanium miniplates (group A) and 37 patients by PODL secured with anchors (group B). Surgical time, intraoperative blood loss, hospital stay, hospitalized cost, VAS scores of neck pain, JOA scores, neck disability index (NDI), and improvement rate of spinal neurological function (IRNF) were recorded before surgery and at 12 months after surgery. Before surgery, at 1 month and 2 years after surgery, the following radiological parameters were recorded and compared on the lateral cervical X-ray images: the distance from the vertical axis of C2 sagittal plane to the posterior superior edge of C7 (C2-7 SVA), the inclusion angle of tangent between C2 and C7 trailing edge (C2-7 Cobb angle), and the intersection angle between the upper edge of T1 and the horizontal line (T1 Slope).ResultComparing the two groups, there were no significant differences in surgical time, intraoperative blood loss, hospital stay, VAS, JOA, and NDI scores before surgery (P > 0.05); however, the hospitalized cost of group A were much higher than those of the group B (P < 0.05). At 2 years after surgery in the two groups, there was a significant reduction in VAS and NDI scores (P < 0.05), and JOA scores increased significantly (P < 0.05). In addition, there were no significant differences in VAS, JOA and IRNF between the two groups (P > 0.05); however, NDI scores of group A were better than those of group B (P < 0.05). In radiological parameters, before surgery, the two groups showed no significant differences in C2-7 SVA, C2-7 Cobb angle, and T1 slope (P > 0.05); however, after surgery, C2-7 SVA and T1 slope increased (P < 0.05), while C2-7 Cobb angle decreased (P < 0.05). At 2 years after surgery, the two groups did not differ significantly in C2-7 Cobb angle and T1 slope (P > 0.05), while C2-7 SVA of group A was superior to that of group B (P < 0.05). The difference value of C2-7 SVA measured before and after surgery was correlated negatively with that of NDI scores (P < 0.05).ConclusionPODL secured with titanium miniplates or anchors achieved good clinical efficacy in the treatment of MCSM. However, the patients with miniplates feel a better cervical functional status, while those with anchors spend less on hospitalization. Both methods lead to anteversion of cervical spine, but cervical sagittal balance after miniplates is better than that of anchors.

Clinical and Radiographic Outcomes of Cervical Open-Door Laminoplasty Withmodified Centerpiece Mini-Plate Fixation and Extensor Attachment Point Reconstruction in Treating Cervical Spondylotic Myelopathy

“…During open-door laminoplasty, pruning or excision of the spinous processes causes damage to the supraspinous ligament and interspinous ligaments and also removes the spinal attachment points of the posterior cervical muscles. Destruction of the muscle-ligament complex and the loss of muscle attachment points can result in atrophy of the posterior cervical muscles and weakening of the tension band can lead to a loss of cervical curvature and even cervical kyphosis [2,7,9,15]. When performing open-door laminoplasty at C3-7, in order to fully expose the superior border of the C3 lamina and the ligamentum avum between the C2/3 lamina, partial dissection of thesemispinalis cervicis from the C2 spinous process is required [6].…”

“…The primary manifestations are postoperative neck and shoulder pain accompanied by neck muscle stiffness, tension, discomfort, soreness, or swelling [3,5,7,12,[14][15]20]. The mechanisms of postoperative AS development remain unclear but may be related to posterior cervical muscle atrophy, change in cervical curvature or lamina open angle, injury of the muscle-ligament complex, joint capsule damage, cervical instability, or other factors [2][3][4][5]7,9,12,[14][15][16][17][18][19][20][21]. Spine surgeons have tried to reduce AS by improving surgical technique [2,7,9,12,15], preserving muscle attachment points [7,9,17,22], reconstructing the muscle-ligament complex [18], implanting an appropriate internal xation device [5], and prescribing postoperative rehabilitation exercises [23] and physical therapy [24]; however, all have achieved various results.…”

“…CSM patients with severe spinal cord compression or multisegmental compression (≥3 levels) are often treated surgically with a posterior cervical approach. Opendoor laminoplasty is a classic posterior decompression technique that has numerous advantages including relative simplicity, short learning curve, adequate spinal cord decompression, less loss of cervical motion segments, and relatively complete cervical spinal canal after surgery [2][3].…”

Is correction of kyphosis necessary by posterior approach for the treatment of multilevel cervical degenerative myelopathy? An observational study

“…There are several limitations need to be considered in our study. Over the last decade, many modified anterior or posterior surgical approaches for the treatment of multilevel CDM with kyphosis, including multilevel anterior cervical discectomy with fusion [29], modified unilateral open-door laminoplasty with PMLC preservation [25], laminoplasty with titanium miniplates fixation [30,31] and combined anterior-posterior fusion, had been developed and obtained favorable outcomes, and additionally reduced the incidence of the long-term surgery-related complications. This study still needs other parameters to comprehensively evaluate the results, including T1 slope, C2-7 ROM, C2-7 sagittal vertical axis (C2-7 SVA) and cephalad vertebral level undergoing laminoplasty (CVLL).…”

Influence of fixed titanium plate position on the effectiveness of open-door laminoplasty for cervical spondylotic myelopathy

“…The recovery rate was calculated as follows: (postoperative score − preoperative score) ÷ (17 − preoperative score) × 100% [ 5 ]. Axial symptoms were recorded as postoperative neck pain with neck stiffness, shoulder stiffness, or both and were evaluated by grading criteria [ 2 , 6 ]: severe (analgesic or local injection regularly required), moderate (physiotherapy or therapeutic compress regularly required), or mild (no treatment required). C 5 palsy is defined as a new occurrence of paralysis of the deltoid and/or biceps brachii after surgery, usually with mild myasthenia and C 5 dermatome sensation disturbances [ 5 ].…”