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. 2014 Nov;48(6):582-6.
doi: 10.4103/0019-5413.144225.

All levels versus alternate levels plate fixation in expansive open door cervical laminoplasty

Zheng-Fei Wang  1 , Guang-Dong Chen  2 , Feng Xue  3 , Xiao-Wen Sheng  3 , Hui-Lin Yang  2 , Jun Qian  2
Affiliations

All levels versus alternate levels plate fixation in expansive open door cervical laminoplasty

Zheng-Fei Wang et al. Indian J Orthop. 2014 Nov.

Abstract

Background: Expansive open door laminoplasty with the use of titanium miniplate is becoming popular. Usually, the plate is applied at each level to prevent re-closure of the opened lamina. However, it is also used at alternating levels (i.e., C3, C5 and C7) in clinical settings in order to reduce the cost. Whether they have any difference in clinical efficacy? There is a lack of comparative data between the two kinds of plate fixation in the literature.

Materials and methods: 83 patients who underwent cervical laminoplasty with alternating levels plate fixation (51 patients in Group A) or all levels plate fixation (32 patients in Group B) between January 2008 and October 2012 were evaluated in our institute retrospectively. Clinical and radiologic outcomes were assessed.

Results: No statistical difference was found in the mean operation time, blood loss, incidence of significant axial symptoms and C5 palsy, preoperative anteroposterior diameter (APD) and preoperative Japanese Orthopedic Association score between the two groups. However, Group B showed a higher rate of neurologic recovery after surgery. Postoperative increased APD and open angle in Group B were significantly larger than Group A. The mean cost for Group B (12801 ± 460.6 USD) was higher than Group A (8906 ± 566.7 USD).

Conclusions: Despite the higher cost of all level fixation, it is more effective in maintaining the expansion of the spinal canal and can obtain better clinical improvement compared to alternating levels fixation.

Keywords: Cervical myelopathy; Spinal cord compression; cervical vertebrae; compressive; laminoplasty; myelopathy; open door.

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Conflict of interest statement

Conflict of Interest: None.

Figures

Figure 1
Figure 1
Preoperative X-ray showing (a) anteroposterior diameter measured using Wolf's method in Group A (b) anteroposterior diameter measured using Wolf's method in Group B (c) Postoperative X-ray illustrating the oval or teardrop silhouette of the elevated lamina, the increased anteroposterior diameter (APD) measurements, alternating levels (C3, C5 and C7) fixation and less increase of APD in C6 level (d) Postoperative lateral X-ray showing all levels (C3, C4, C5, C6 and C7) fixation and no significant difference of increased anteroposterior diameter in each level
Figure 2
Figure 2
Postoperative computed tomography showing the open angle of 32° at C6 without plate fixation
Figure 3
Figure 3
Postoperative computed tomography showing the open angle of 39° at C5 with plate fixation
Figure 4
Figure 4
Postoperative sagittal magnetic resonance imaging T2W showing insufficient decompression at C6 level with alternate levels (C3, C5 and C7) fixation
See this image and copyright information in PMC

References

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