Comparison of the effects of different fixation methods on open-door side in posterior expansive open-door laminoplasty / 中华骨科杂志

ABSTRACT

Objective To investigate the clinical outcome and complications of different types of expansive open door laminoplasty in cervical spondylotic myelopathy.Methods From December 2008 to June 2012,221 patients with cervical spondylotic myelopathy treated with expansive open-door laminoplasty were divided into micro-titanium plate fixed group (96 cases),wire hanging fixed group(66 cases),anchor suspension fixed group (59 cases).The clinical outcome was evaluated including JOA score,operation time,bleeding volume,spinal cord pressure (a/M),cervical range of motion (ROM),open door angle,posterior shift distance of spinal cord and postoperative complications.Results All patients were followed up for more than 2 years.There were no significant differences in general condition,operation time,intraoperative blood loss,preoperative and postoperative 2 years JOA score,JOA score improvement rate,spinal cord shift distance,spinal cord compression among three groups;In the incidence of C5 nerve root paralysis,there was no significant difference between the silk suspension fixation group (12.1％) and the anchored suspension group (11.9％).The incidence of C5 nerve root paralysis for microplate fixation group (2.1％) was significantly lower than that of the silk suspension fixation group and anchored suspension fixation group,and the difference was statistically significant.There was no significant difference in the fusion rate between the 3-month and 6-month portal arteries in the group of silk suspension fixation group(65％,82％) and anchor fixation group(61％,82％).The fusion rate of the microtiter plate fixation group(90％,98％) was significantly higher than that of the silk suspension group and the anchorage group at 3 months and 6 months after operation.There were no significant differences in the incidence of recurrence,the total amount of cervical spine loss and the incidence of axial symptoms after 6 months of operation in the suspension group and the anchor suspension group.The incidence of occlusion,the total amount of cervical spine loss and the incidence of axial symptoms were significantly lower in the micro titanium plate fixation group than those in the silk suspension group and the anchorage fixation group,the difference was statistically significant.Conclusion Using micro-titanium plate to fix the side of open door could achieve full spinal cord decompression and access to satisfactory neurological improvement rate.At the same time,compared with the traditional silk or anchor suspension,the use of micro-titanium plate is more conducive to the door axis bone healing,prevent the occurrence of reclosing,significantly reduce the loss of postoperative cervical range of motion,and reduce the incidence of axial symptoms with the satisfaction of the clinical outcome.