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

Wang ZF, Chen GD, Xue F, Sheng XW, Yang HL, Qian J - Indian J Orthop (2014)

Bottom Line: 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?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.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics, 1 Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China ; Department of Orthopedics, Changshu No. 1 People's Hospital, Changshu 215500, Jiangsu Province, China.

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.

No MeSH data available.


Related in: MedlinePlus

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
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4232827&req=5

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

Mentions: Radiologic data was also analyzed. Preoperative anteroposterior diameter (APD) was measured using Wolf's method [Figures 1a and b].7 Postoperative APD was measured from the middle of the posterior border of the vertebral body to the anterior cortex of the elevated lamina [Figures 1c and d]. The mean increased APD was determined by: ([Postoperative APD of C3 − preoperative APD of C3] + [postoperative APD of C4 − preoperative APD of C4] + [postoperative APD of C5 − preoperative APD of C5] + [postoperative APD of C6 − preoperative APD of C6] + [postoperative APD of C7 − preoperative APD of C7])/5. The CT scan was used to measure opening angle.4 The open angle of CT scans is shown between the lines from hinge to the ends of the divided lamina at the open side [Figures 2 and 3].


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

Wang ZF, Chen GD, Xue F, Sheng XW, Yang HL, Qian J - Indian J Orthop (2014)

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
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4232827&req=5

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
Mentions: Radiologic data was also analyzed. Preoperative anteroposterior diameter (APD) was measured using Wolf's method [Figures 1a and b].7 Postoperative APD was measured from the middle of the posterior border of the vertebral body to the anterior cortex of the elevated lamina [Figures 1c and d]. The mean increased APD was determined by: ([Postoperative APD of C3 − preoperative APD of C3] + [postoperative APD of C4 − preoperative APD of C4] + [postoperative APD of C5 − preoperative APD of C5] + [postoperative APD of C6 − preoperative APD of C6] + [postoperative APD of C7 − preoperative APD of C7])/5. The CT scan was used to measure opening angle.4 The open angle of CT scans is shown between the lines from hinge to the ends of the divided lamina at the open side [Figures 2 and 3].

Bottom Line: 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?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.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics, 1 Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China ; Department of Orthopedics, Changshu No. 1 People's Hospital, Changshu 215500, Jiangsu Province, China.

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.

No MeSH data available.


Related in: MedlinePlus