Mini-plate fixation versus suture suspensory fixation in cervical laminoplasty: A meta-analysis

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.

Figure 1

Flow diagram of study selection.

Figure 2

Forest plots of preoperative JOA (A), postoperative JOA (B), and JOA scores improvement rate (C) in the mini-plate fixation group and suture suspensory fixation group.

Figure 3

Forest plots of preoperative VAS (A) and postoperative VAS (B) in the mini-plate fixation group and suture suspensory fixation group.

Figure 4

Forest plots of axial symptoms (A) and C5 palsy (B) in the mini-plate fixation group and suture suspensory fixation group.

Figure 5

Forest plots of preoperative ROM (A) and postoperative ROM (B) in the mini-plate fixation group and suture suspensory fixation group.

Figure 6

Forest plots of preoperative cervical lordosis (A) and postoperative cervical lordosis (B) in the mini-plate fixation group and suture suspensory fixation group.

Figure 7

Forest plots of preoperative anteroposterior diameter of the spinal canal (A), postoperative anteroposterior diameter of the spinal canal (B), and open angle (C) in the mini-plate fixation group and suture suspensory fixation group.

Figure 8

Forest plots of preoperative cross-sectional area of the spinal canal (A) and postoperative cross-sectional area of the spinal canal (B) in the mini-plate fixation group and suture suspensory fixation group.

Figure 9

Forest plots of operation time (A) and blood loss (B) in the mini-plate fixation group and suture suspensory fixation group.

Figure 10

Funnel plots for operation time (A), blood loss (B), preoperative JOA (C), axial symptom (D), and preoperative cervical lordosis (E).