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

European Spine Journal volume 27, pages 1365–1374 (2018)Cite this article

Abstract

Purpose

To compare the clinical and radiological outcomes between skipped-level and all-level plating for cervical laminoplasty.

Methods

Patients with cervical spondylotic myelopathy (CSM) treated by open-door laminoplasty with minimum 2-year postoperative follow-up were included. All patients had opening from C3–6 or C3–7 and were divided into skipped-level or all-level plating groups. Japanese Orthopaedic Association (JOA) scores and canal measurements were obtained preoperatively, immediate (within 1 week) postoperatively, and at 2, 6 weeks, 3, 6 and 12 months postoperatively. Paired t test was used for comparative analysis. Receiver operating characteristic analysis was used to determine the canal expansion cutoff for spring-back closure.

Results

A total of 74 subjects were included with mean age of 66.1 ± 11.3 years at surgery. Of these, 32 underwent skipped-level plating and 42 underwent all-level plating. No significant differences were noted between the two groups at baseline and follow-up. Spring-back closure was observed in up to 50% of the non-plated levels within 3 months postoperatively. The cutoff for developing spring-back closure was 7 mm canal expansion for C3–6. No differences were observed in JOA scores and recovery rates between the two groups. None of the patients with spring-back required reoperation.

Conclusions

There were no significant differences between skipped-level and all-level plating in terms of JOA or recovery rate, and canal diameter differences. This has tremendous impact on saving costs in CSM management as up to two plates per patient undergoing a standard C3–6 laminoplasty may be omitted instead of four plates to every level to achieve similar clinical and radiological outcomes.

Level of evidence

III.

Graphical abstract

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References

  1. Kalsi-Ryan S, Karadimas SK, Fehlings MG (2013) Cervical spondylotic myelopathy: the clinical phenomenon and the current pathobiology of an increasingly prevalent and devastating disorder. Neurosci Rev J Bringing Neurobiol Neurol Psychiatry 19:409–421

    Google Scholar 

  2. Smith ZA, Buchanan CC, Raphael D, Khoo LT (2011) Ossification of the posterior longitudinal ligament: pathogenesis, management, and current surgical approaches. A review. Neurosurg Focus 30:E10

    Article  PubMed  Google Scholar 

  3. Shigematsu H, Cheung JP, Mak KC, Bruzzone M, Luk KD (2017) Cervical spinal canal stenosis first presenting after spinal cord injury due to minor trauma: an insight into the value of preventive decompression. J Orthop Sci 22:22–26

    Article  PubMed  Google Scholar 

  4. Wang SJ, Jiang SD, Jiang LS, Dai LY (2011) Axial pain after posterior cervical spine surgery: a systematic review. Eur Spine J 20:185–194

    Article  PubMed  Google Scholar 

  5. Hirabayashi K, Satomi K (1988) Operative procedure and results of expansive open-door laminoplasty. Spine (Phila Pa 1976) 13:870–876

    Article  CAS  Google Scholar 

  6. Hirabayashi K, Watanabe K, Wakano K, Suzuki N, Satomi K, Ishii Y (1983) Expansive open-door laminoplasty for cervical spinal stenotic myelopathy. Spine (Phila Pa 1976) 8:693–699

    Article  CAS  Google Scholar 

  7. Hirabayashi K, Miyakawa J, Satomi K, Maruyama T, Wakano K (1981) Operative results and postoperative progression of ossification among patients with ossification of cervical posterior longitudinal ligament. Spine (Phila Pa 1976) 6:354–364

    Article  CAS  Google Scholar 

  8. Liu FY, Ma L, Huo LS, Cao YX, Yang DL, Wang H, Yang SD, Ding WY (2017) Mini-plate fixation versus suture suspensory fixation in cervical laminoplasty: a meta-analysis. Medicine (Baltimore) 96:e6026

    Article  Google Scholar 

  9. Wang HQ, Mak KC, Samartzis D, El-Fiky T, Wong YW, Luo ZJ, Kang X, Cheung WY, Luk KD, Cheung KM (2011) “Spring-back” closure associated with open-door cervical laminoplasty. Spine J Off J N Am Spine Soc 11:832–838

    Article  Google Scholar 

  10. Chen G, Luo Z, Nalajala B, Liu T, Yang H (2012) Expansive open-door laminoplasty with titanium miniplate versus sutures. Orthopedics 35:e543–e548

    Article  PubMed  Google Scholar 

  11. O’Brien MF, Peterson D, Casey AT, Crockard HA (1996) A novel technique for laminoplasty augmentation of spinal canal area using titanium miniplate stabilization. A computerized morphometric analysis. Spine (Phila Pa 1976) 21:474–483 (discussion 484)

    Article  Google Scholar 

  12. Tung KL, Cheung P, Kwok TK, Wong KK, Mak KH, Wong WC (2015) Single-door cervical laminoplasty using titanium miniplates alone. J Orthop Surg (Hong Kong) 23:174–179

    Article  Google Scholar 

  13. Wolf BS, Khilnani M, Malis L (1956) The sagittal diameter of the bony cervical spinal canal and its significance in cervical spondylosis. J Mt Sinai Hosp N Y 23:283–292

    PubMed  CAS  Google Scholar 

  14. Heller JG, Edwards CC II, Murakami H, Rodts GE (2001) Laminoplasty versus laminectomy and fusion for multilevel cervical myelopathy: an independent matched cohort analysis. Spine (Phila Pa 1976) 26:1330–1336

    Article  CAS  Google Scholar 

  15. Jiang YQ, Li XL, Zhou XG, Bian C, Wang HM, Huang JM, Dong J (2017) A prospective randomized trial comparing anterior cervical discectomy and fusion versus plate-only open-door laminoplasty for the treatment of spinal stenosis in degenerative diseases. Eur Spine J 26:1162–1172

    Article  PubMed  Google Scholar 

  16. Chen H, Deng Y, Li T, Gong Q, Song Y, Liu H (2015) Clinical and radiography results of mini-plate fixation compared to suture suspensory fixation in cervical laminoplasty: a five-year follow-up study. Clin Neurol Neurosurg 138:188–195

    Article  PubMed  Google Scholar 

  17. Mochida J, Nomura T, Chiba M, Nishimura K, Toh E (1999) Modified expansive open-door laminoplasty in cervical myelopathy. J Spinal Disord 12:386–391

    Article  PubMed  CAS  Google Scholar 

  18. Deutsch H, Mummaneni PV, Rodts GE, Haid RW (2004) Posterior cervical laminoplasty using a new plating system: technical note. J Spinal Disord Tech 17:317–320

    Article  PubMed  Google Scholar 

  19. Gandhoke G, Wu JC, Rowland NC, Meyer SA, Gupta C, Mummaneni PV (2011) Anterior corpectomy versus posterior laminoplasty: is the risk of postoperative C-5 palsy different? Neurosurg Focus 31:E12

    Article  PubMed  Google Scholar 

  20. Meyer SA, Wu JC, Mummaneni PV (2011) Laminoplasty outcomes: is there a difference between patients with degenerative stenosis and those with ossification of the posterior longitudinal ligament? Neurosurg Focus 30:E9

    Article  PubMed  Google Scholar 

  21. Park AE, Heller JG (2004) Cervical laminoplasty: use of a novel titanium plate to maintain canal expansion—surgical technique. J Spinal Disord Tech 17:265–271

    Article  PubMed  Google Scholar 

  22. Rhee JM, Register B, Hamasaki T, Franklin B (2011) Plate-only open door laminoplasty maintains stable spinal canal expansion with high rates of hinge union and no plate failures. Spine (Phila Pa 1976) 36:9–14

    Article  Google Scholar 

  23. Wang LN, Wang L, Song YM, Yang X, Liu LM, Li T (2016) Clinical and radiographic outcome of unilateral open-door laminoplasty with alternative levels centerpiece mini-plate fixation for cervical compressive myelopathy: a five-year follow-up study. Int Orthop 40:1267–1274

    Article  PubMed  Google Scholar 

  24. Yang HL, Chen GD, Zhang HT, Wang L, Luo ZP (2013) Open-door laminoplasty with plate fixation at alternating levels for treatment of multilevel degenerative cervical disease. J Spinal Disord Tech 26:E13–E18

    Article  PubMed  Google Scholar 

  25. Abdullah KG, Yamashita T, Steinmetz MP, Lubelski D, Wang JC, Benzel EC, Mroz TE (2012) Open-door cervical laminoplasty with preservation of posterior structures. Glob Spine J 2:15–20

    Article  Google Scholar 

  26. Hartman RA, Tisherman RE, Wang C, Bell KM, Lee JY, Sowa GA, Kang JD (2016) Mechanical role of the posterior column components in the cervical spine. Eur Spine J 25:2129–2138

    Article  PubMed  Google Scholar 

  27. Wang ZF, Chen GD, Xue F, Sheng XW, Yang HL, Qian J (2014) All levels versus alternate levels plate fixation in expansive open door cervical laminoplasty. Indian J Orthop 48:582–586

    Article  PubMed  PubMed Central  Google Scholar 

  28. Humadi A, Chao T, Dawood S, Tacey M, Barmare A, Freeman B (2017) A meta-analysis of cervical laminoplasty techniques: are mini-plates superior? Glob Spine J 7:373–381

    Article  Google Scholar 

  29. Cheung PWH, Wong CKH, Lau ST, Cheung JPY (2018) Psychometric validation of the adapted traditional Chinese (Hong Kong) version of the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ). Spine 43:E242–E249

    Article  PubMed  Google Scholar 

  30. Fukui M, Chiba K, Kawakami M, Kikuchi S, Konno S, Miyamoto M, Seichi A, Shimamura T, Shirado O, Taguchi T, Takahashi K, Takeshita K, Tani T, Toyama Y, Wada E, Yonenobu K, Tanaka T, Hirota Y, Subcommittee on Low Back P, Cervical Myelopathy Evaluation of the Clinical Outcome Committee of the Japanese Orthopaedic A (2007) An outcome measure for patients with cervical myelopathy: Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ): part 1. J Orthop Sci 12:227–240

    Article  PubMed  PubMed Central  Google Scholar 

  31. Tanaka N, Konno S, Takeshita K, Fukui M, Takahashi K, Chiba K, Miyamoto M, Matsumoto M, Kasai Y, Kanamori M, Matsunaga S, Hosono N, Kanchiku T, Taneichi H, Hashizume H, Kanayama M, Shimizu T, Kawakami M (2014) An outcome measure for patients with cervical myelopathy: the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ): an average score of healthy volunteers. J Orthop Sci 19:33–48

    Article  PubMed  Google Scholar 

  32. Ikegami S, Takahashi J, Misawa H, Tsutsumimoto T, Yui M, Kuraishi S, Futatsugi T, Uehara M, Oba H, Kato H (2017) Spinal cord MRI signal changes at 1 year after cervical decompression surgery is useful for predicting midterm clinical outcome: an observational study using propensity scores. Spine J. https://doi.org/10.1016/j.spinee.2017.09.004

    Article  PubMed  Google Scholar 

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Affiliations

  1. Department of Orthopaedics and Traumatology, The University of Hong Kong, 5/F Professorial Block, Queen Mary Hospital, Pokfulam, Hong Kong SAR, China

    Jason Pui Yin Cheung, Prudence Wing Hang Cheung, Amy Yim Ling Cheung, Darren Lui & Kenneth M. C. Cheung

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  1. Jason Pui Yin Cheung
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  2. Prudence Wing Hang Cheung
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Correspondence to Jason Pui Yin Cheung.

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Cheung, J.P.Y., Cheung, P.W.H., Cheung, A.Y.L. et al. Comparable clinical and radiological outcomes between skipped-level and all-level plating for open-door laminoplasty. Eur Spine J 27, 1365–1374 (2018). https://doi.org/10.1007/s00586-018-5533-0

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  • DOI: https://doi.org/10.1007/s00586-018-5533-0

Keywords

  • Cervical spondylotic myelopathy
  • Plates
  • Spring-back
  • Skipped-level
  • Laminoplasty