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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

Postoperative sagittal magnetic resonance imaging T2W showing insufficient decompression at C6 level with alternate levels (C3, C5 and C7) fixation
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Figure 4: Postoperative sagittal magnetic resonance imaging T2W showing insufficient decompression at C6 level with alternate levels (C3, C5 and C7) fixation

Mentions: Average JOA score in Group A improved from 9.49 ± 1.57 points preoperatively to 13.80 ± 1.23 points at the last followup. In Group B, average JOA score improved from 9.63 ± 1.48 points preoperatively to 14.22 ± 0.75 points at the last followup. The rate of recovery, which indicates the degree of normalization after surgery, is calculated using Hirabayashi's formula: (Postoperative score − preoperative score) ×100/(17 [full score] − preoperative score). There is an advantage of using the recovery rate that we can compare the treatment result of this study to the previous reports. The rate of recovery was 57.42 ± 13.23% for Group A and 62.16 ± 8.24% for Group B. Statistical difference in the rate of recovery was found between the two groups. Group A had a lower rate of recovery than Group B [Table 2 and Figure 4].


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)

Postoperative sagittal magnetic resonance imaging T2W showing insufficient decompression at C6 level with alternate levels (C3, C5 and C7) fixation
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Postoperative sagittal magnetic resonance imaging T2W showing insufficient decompression at C6 level with alternate levels (C3, C5 and C7) fixation
Mentions: Average JOA score in Group A improved from 9.49 ± 1.57 points preoperatively to 13.80 ± 1.23 points at the last followup. In Group B, average JOA score improved from 9.63 ± 1.48 points preoperatively to 14.22 ± 0.75 points at the last followup. The rate of recovery, which indicates the degree of normalization after surgery, is calculated using Hirabayashi's formula: (Postoperative score − preoperative score) ×100/(17 [full score] − preoperative score). There is an advantage of using the recovery rate that we can compare the treatment result of this study to the previous reports. The rate of recovery was 57.42 ± 13.23% for Group A and 62.16 ± 8.24% for Group B. Statistical difference in the rate of recovery was found between the two groups. Group A had a lower rate of recovery than Group B [Table 2 and Figure 4].

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