Comparison of long-term clinical and radiographic outcomes between alternative-level and all-level fixation unilateral open-door laminoplasty |
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| Affiliation: | 1. Hospital Clinico-Universitario de Valladolid, Calle Ramon y Cajal S/n, 47008 Valladolid, Spain;2. Direttore U.O.C. Radiologia, Ospedale SS. Trinità ASL8, via Is Mirrionis 92, 09121 Cagliari, Sardinia, Italy;3. Department of Radiology, Bois-Cerf Clinic, Avenue d''Ouchy 31, 1006 Lausanne, Switzerland;4. Department of Orthopedic, Trauma and Spine surgery, CHU de La Timone, 264 rue Saint Pierre, 13385 Marseille, France;5. Department of Neurosurgery, Locomotor Centre, CHU Brest Cavale Blanche, Bd Tanguy Prigent, 29609 Brest, France;6. Chefarzt Wirbelsäulenchirurgie, Loretto-Krankenhaus Freiburg, Mercystr. 6-14, 79100 Freiburg, Germany;7. Department of Orthopedic Surgery, HFR Fribourg, Cantonal Hospital, 1er étage, Case postale 1708, Fribourg, Switzerland;8. Neurosurgery Unit, Hôpital Jean Minjoz, 3 Boulevard Alexandre Fleming, 25030 Besançon, France;9. Krankenhaus NEUWERK, Sankt Augustinus Kliniken, Dünner Strasse 214-216, 41066 Mönchengladbach, Germany;10. Interventional Neuroradiology, Hospital Universitario Marqués de Valdecilla, Av. Valdecilla, s/n, 39008 Santander, Spain;11. APHM, Hopital Nord, Pavillon Mistral, 1er étage, Chemin des Bourrely, 13915 Marseille, France;12. Neurosurgery Unit, CHU La Timone-Hôpital Adultes-5eme étage, 264 rue Saint Pierre, 13385 Marseille, France;13. Klinik und Poliklinik für Orthopädie und Unfallchirurgie, UniversitätsklinikumBonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany;1. Department of Neurosurgery, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA;2. Department of Radiology, Interventional Neuroradiology, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA;1. Department of Orthopaedic Surgery, St. Antonius Hospital, Utrecht, The Netherlands;2. Department of Orthopaedic Surgery, OLVG, Amsterdam, The Netherlands;3. Department of Hematology, St. Antonius Hospital, Utrecht, The Netherlands;4. Department of Radiology, OLVG, Amsterdam, The Netherlands;5. Department of Hematology, OVLG, Amsterdam, The Netherlands;1. Department of Neurosurgery, Bahçeşehir University School of Medicine, Goztepe Medikal Park Hastanesi, Nöroşirürji Kliniği E5 Üzeri 23 Nisan Sok. No: 17 Merdivenköy Kadıköy-Istanbul 34732, Turkey;2. Department of Pathology, Bahçeşehir University School of Medicine, Goztepe Medical Park Hospital, Kerem Aydınlar Kampüsü-Patoloji Ana Bilim Dalı Kayışdağı Cad. No:32 Ataşehir/Istanbul 34752, Turkey;3. Department of Radiology, Bahçeşehir University School of Medicine, Goztepe Medical Park Hospital, 11. kisim, Yasemin Apt, D blok. Daire 35 Ataköy-Bakırkoy, Istanbul 34158, Turkey |
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| Abstract: | BACKGROUND CONTEXTTitanium mini-plate has been used in unilateral open-door laminoplasty to maintain the open angle of laminae. Previously, both all-level fixation (C3–C7) and alternative-level (C3, C5, C7) unilateral open-door laminoplasty have been proven to have satisfactory clinical outcomes. However, whether they could achieve similar long-term clinical and radiographic efficacy is still questionable.PURPOSETo compare the long-term clinical and radiological outcomes between alternative-level and all-level fixation unilateral open-door laminoplasty with a mini-plate fixation system.STUDY DESIGN/SETTINGRetrospective comparative study.PATIENT SAMPLENinety-one patients who underwent unilateral open-door laminoplasty.OUTCOME MEASURESClinical results including Japanese Orthopedic Association score, Visual Analogue Score, Neck Dysfunction Index score. Radiographic results including cervical curvature index, cervical range of motion, and the spinal canal expansive parameters, including anteroposterior diameter, Pavlov's ratio, and open angle.METHODSBetween April 2007 and June 2011, 91 patients with minimum 7-year postoperative follow-up were included. Thirty-eight underwent alternative-level fixation (group A) and 53 underwent all-level fixation (group B). Demographic data, including age, gender, operative time, blood loss, and cost, were collected and compared between the two groups. Clinical and radiographic data were obtained preoperatively, at 3 and 6 months and 1 and 3 years postoperatively, as well as at final follow-up. The difference between the two groups and between different time points within one group was compared.RESULTSBoth groups obtained satisfactory clinical outcomes till the final follow-up. No statistic difference was found in Japanese Orthopedic Association, Visual Analogue Score, and Neck Dysfunction Index between the two groups throughout the whole follow-up. Both groups maintained APD and Pavlov's ratio well till follow-up. However, statistic difference was found in the open angle between two groups at final follow-up (34.17±2.75° vs. 36.19±1.80°, p<.05). When we subdivided the cervical segments in group A, we found the mini-plate segments showed maintenance in open angle but a 4.52° decrease in suture segments. The mean cost in group B (17,669.82±1,157.65 $) was significantly higher than in group A (11,452.19±871.07 $; p<.05).CONCLUSIONSDespite a difference in the maintenance of open angle, both fixation methods achieved satisfactory clinical outcomes. We believe alternative-level fixation is also a safe, effective, and economical fixation method. |
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