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Background Open-door laminoplasty is a classical decompression method used to treat cervical spondylotic myelopathy. However, hinge fracture displacement (HFD) is a common occurrence during this procedure. The current study aimed to investigate the safety and efficacy of a combined imbrication axle reconstruction and Z-type titanium plate fixation method for HFD during open-door laminoplasty. Methods In total, 617 patients with cervical spondylotic myelopathy who underwent C3–C7 open-door laminoplasty from March 2015 to October 2018 were included in this retrospective study. Overall, 73 patients developed HFD during surgery. Of these, 43 underwent combined imbrication axle reconstruction and Z-type titanium plate fixation (IRZF group) and 30 underwent traditional titanium plate fixation (TF group). Data such as the operative time, intraoperative blood loss volume, and distribution of fractured hinges were recorded. Both groups were compared in terms of improvement in neurologic function, cervical curvature index, hinge fusion rate, incidence of C5 palsy, severity of axial symptoms, and development of complications. Results The operative time and intraoperative blood loss were slightly higher in the IRZF group than in the TF group; however, the differences were not significant (p > 0.05). Furthermore, there was no significant difference between the groups in terms of the number of fractured segments and the distribution of fractured hinges (p > 0.05). The cervical curvature index did not decline in the two groups (p > 0.05). The IRZF group had a higher hinge fusion rate than the TF group at 3 (79.6 vs. 57.1%) and 12 (93.9 vs. 74.3%) months postoperatively (p < 0.05). There was no significant difference in the incidence of C5 palsy between the two groups (9.3 vs. 6.7%; p > 0.05). However, the TF group had more severe axial symptoms than the IRZF group (p < 0.05). The neurologic function of the two groups increased postoperatively as per the Japanese Orthopaedic Association scoring system (p < 0.05). Nevertheless, there was no significant difference in terms of neurologic function at any observational time point (p > 0.05). One patient in the TF group with hinge nonunion underwent laminectomy due to lamina displacement into the spinal canal and nerve root compression. Conclusion In patients with HFD, IRZF facilitates a more intimate contact between the lamina and the lateral mass and, therefore, achieves fractured hinge fusion without additional surgical trauma. This technical improvement can significantly promote neurologic recovery, decrease the severity of axial symptoms, and prevent the development of spinal cord or nerve root recompression. [ABSTRACT FROM AUTHOR]

Objective Both two‐level anterior cervical corpectomy and fusion (t‐ACCF) and posterior open‐door laminoplasty (ODLP) are effective surgical procedures for the treatment of ossification of the posterior longitudinal ligament (OPLL). Previous studies have identified different effects of different surgical procedures on the upper and subaxial cervical spine (UCS, SCS), however, there are no studies on the effects of t‐ACCF and ODLP on the occipito‐atlantoaxial complex. Therefore, the purpose of this study is to compare the changes in sagittal parameters and range of motion (ROM) of the occipito‐atlantoaxial complex in OPLL patients treated with t‐ACCF and ODLP. Methods This was a retrospective study that included 74 patients who underwent t‐ACCF or ODLP for the treatment of OPLL from January 2012 to August 2022 at our institution. Preoperative, 3‐month, and 1‐year postoperative cervical neutral, flexion‐extension, and lateral flexion radiographs were taken. Sagittal parameters including Cobb angle of C2‐7, C0‐2, C0‐1, C1‐2, C2 slope, and the ROM were measured. The clinical outcome was assessed using the JOA, VAS, and NDI scores preoperatively and at 3 and 12 months postoperatively. Multiple linear regression was employed to identify factors influencing changes in UCS. Results In the ODLP group, the SCS (C2‐7) Cobb angle was significantly reduced (12.85 ± 10.0 to 7.68 ± 11.27; p

Objective: Both two‐level anterior cervical corpectomy and fusion (t‐ACCF) and posterior open‐door laminoplasty (ODLP) are effective surgical procedures for the treatment of ossification of the posterior longitudinal ligament (OPLL). Previous studies have identified different effects of different surgical procedures on the upper and subaxial cervical spine (UCS, SCS), however, there are no studies on the effects of t‐ACCF and ODLP on the occipito‐atlantoaxial complex. Therefore, the purpose of this study is to compare the changes in sagittal parameters and range of motion (ROM) of the occipito‐atlantoaxial complex in OPLL patients treated with t‐ACCF and ODLP. Methods: This was a retrospective study that included 74 patients who underwent t‐ACCF or ODLP for the treatment of OPLL from January 2012 to August 2022 at our institution. Preoperative, 3‐month, and 1‐year postoperative cervical neutral, flexion‐extension, and lateral flexion radiographs were taken. Sagittal parameters including Cobb angle of C2‐7, C0‐2, C0‐1, C1‐2, C2 slope, and the ROM were measured. The clinical outcome was assessed using the JOA, VAS, and NDI scores preoperatively and at 3 and 12 months postoperatively. Multiple linear regression was employed to identify factors influencing changes in UCS. Results: In the ODLP group, the SCS (C2‐7) Cobb angle was significantly reduced (12.85 ± 10.0 to 7.68 ± 11.27; p < 0.05), and the UCS (C0‐2) Cobb angle was significantly compensated for at 1 year postoperatively compared with the t‐ACCF group (3.05 ± 4.09 vs 0.79 ± 2.62; p < 0.01). The SCS and lateral flexion ROM of the ODLP group was better maintained than t‐ACCF (14.51 ± 6.00 vs 10.72 ± 3.79; 6.87 ± 4.56 vs 3.81 ± 1.67; p < 0.01). The compensatory increase in C0‐2, C0‐1, and C1‐2 ROM was pronounced in both groups, especially in the ODLP group. The results of multiple linear regression showed that only the surgical procedure was a significant factor influencing UCS. Conclusion: The loss of the SCS Cobb angle was more pronounced in ODLP relative to t‐ACCF, resulting in a significant compensatory increase in UCS and atlantoaxial Cobb angle. The ROM of the UCS, atlantooccipital, and atlantoaxial joints was significantly increased in both groups, this may accelerate degenerative changes in the occipital‐atlantoaxial complex, may leading to poorer outcomes in the long‐term; of these, ODLP should receive more attention. In contrast, t‐ACCF better maintains normal curvature of the SCS and occipito‐atlantoaxial complex but loses more ROM. [ABSTRACT FROM AUTHOR]

Background/Objectives: Expansive open-door laminoplasty results in favorable clinical outcomes for cervical myelopathy. However, some postoperative complications associated with surgical invasiveness, such as axial neck pain and kyphosis, have not been resolved. The use of an exoscope, which is a recently introduced novel magnification tool, allows for traditional open-door laminoplasty with minimal invasiveness. Therefore, we propose the use of exoscopic minimally invasive open-door laminoplasty (exLAP) and present its clinical outcomes during the acute postoperative period. Methods: A total of 28 patients who underwent open-door laminoplasty at C3–C6 were reviewed. Of these patients, 17 underwent exLAP (group M) and 11 underwent conventional Hirabayashi open-door laminoplasty (group H). Outcomes were evaluated using numerical rating scale (NRS) scores for neck pain and the frequency of oral analgesic use from postoperative day 1 to 7. Results: The NRS score for neck pain was significantly lower for patients in group M than for those in group H. Conclusions: ExLAP is a novel, practical, and minimally invasive surgical technique that may alleviate the postoperative axial pain of patients with cervical myelopathy. [ABSTRACT FROM AUTHOR]

Multilevel cervical myelopathy is a common cause of spinal cord dysfunction in adults. Surgical intervention via laminoplasty can provide satisfactory clinical outcomes by expansive decompression of the spinal cord. Traditional suture or bone graft techniques have been associated with insufficient fixation, leading to premature closure and subsequent neurological deterioration. In contrast, plated laminoplasty has been shown to provide stable fixation to maintain canal enlargement, but longer-term outcomes are lacking. To evaluate longer-term clinical outcomes and reoperations associated with plate-only open-door laminoplasty. Retrospective review of prospectively collected data. Postoperative patients who underwent plate-only open door laminoplasty with minimum 5-year follow up. modified Japanese Orthopaedic Association (mJOA) score, Neck Disability Index (NDI), and 12-item Short Form Health Survey (SF-12). All patients at a single academic institution who underwent plate-only open-door cervical laminoplasty from 9/1/2006 to 9/1/2016 were identified to ensure minimum 5 year follow up. Clinical outcomes included the modified Japanese Orthopaedic Association (mJOA) score, the Neck Disability Index (NDI), and the 12-item Short Form Health Survey (SF-12). The occurrence of any repeat operations on the cervical spine was evaluated, as well as its cause. The study team attempted to contact all eligible patients to achieve at least 5 years postoperative follow-up. Pairwise t tests were performed to compare clinical outcomes at preoperative, 6 months, 1-year, and final postoperative follow-up with an α level of 0.05. A total of 774 met the initial inclusion criteria, of which 157 were included in the study (20.3%). Most common reasons for exclusion included inability to reach after 3 attempts (49.48%), inactive phone numbers (20.28%), and patient declining (3.49%). Included patients had an average age of 60.66±10.63 and an average follow-up time of 8.37±2.57 years (minimum 5 years). mJOA scores (preoperative 11.59±2.16) improved significantly at 6-months (14.57±2.07, p<.001), 1-year (15.19±1.95, p<.001), and final follow-up (14.59±2.63, p<.001). NDI (preoperative 33.89±18.54) improved significantly at 6 months (27.89±19.72, p=.03), 1-year (25.96±19.79, p=.01) and final follow-up (17.88±17.17, p<.001). SF-12 MCS (preoperative 44.73) improved significantly at 6 months (52.01, p=.001), 1-year (51.62, p=.008), and final follow-up (52.32, p<.001). No patient underwent reoperations for plate failure or canal closure with recurrent stenosis. Reoperations for progressive spondylosis during the follow up period were rare and occurred in only three patients for new onset radiculopathy (1.9%) and two patients for myelopathy (1.3%) at an average of 3.2 years postoperative. There were no reoperations performed for adjacent segment disease. At a minimum of 5 years and an average of more than 8 years postoperative, laminoplasty was associated with significant and sustained improvements in mJOA, NDI, and SF-12 MCS. Importantly, no patients underwent revision surgery for plate failure or recurrent canal closure. Reoperations for new onset radiculopathy and myelopathy were also very rare over the 8-year average follow-up period, with no reoperations for adjacent segment disease. Plate-only laminoplasty is a durable means of treating multilevel myelopathy with excellent longer-term outcomes and a very low risk of reoperation, either for premature closure or the inevitable spondylotic changes that occur over time in patients with similar baseline characteristics to the study population. [ABSTRACT FROM AUTHOR]

Objective: The C3 & C7 dome-hybrid open-door laminoplasty was proven to be an effective treatment for multi-levels cervical spondylotic myelopathy (CSM). However, its superiority over traditional unilateral open-door laminoplasty (UOLP) remains questionable, and no studies have compared the efficacy of this technique with traditional UOLP. This study aimed to compare the effectiveness of C3 & C7 dome-hybrid open-door laminoplasty with traditional UOLP in treating multi-levels CSM. Methods: A retrospective study of multi-levels CSM with laminoplasty was performed, including 35 cases of traditional UOLP and 27 cases of C3 & C7 dome-hybrid open-door laminoplasty. Radiographic evaluation parameters and clinical outcomes were recorded to evaluate the surgical effectiveness. Results: There was no significant difference in demographic baseline parameters. At the final follow-up, the C2–C7 Cobb angle of the modified group was significantly greater than that of the traditional group (p = 0.026). Meanwhile, the C2–C7 SVA of the modified group was significantly smaller than that of the traditional group (p = 0.009). Clinical outcomes such as VAS, NDI, and SF-12 scores, improved significantly in the modified group compared to the traditional group, while the JOA scores had no significant difference in both groups. There was no significant difference in the overall rate of complications between the two groups. Conclusion: Both techniques have satisfactory outcomes in treating multi-levels CSM. Comparing with traditional UOLP, C3 & C7 dome-hybrid open-door laminoplasty has a greater superiority in reducing postoperative neck pain and maintaining the cervical sagittal alignment. It is proven to be a feasible management for patients with multi-levels CSM. [ABSTRACT FROM AUTHOR]

Objectives The prevalence of multi‐level cervical spinal stenosis complicated with traumatic cervical instability and spinal cord injury (MCSS‐TCISCI) is low, and the optimal surgical approach remains unclear. Open‐door laminoplasty combined with bilateral lateral mass screw fixation (ODL‐BLMSF) is a relatively new surgical technique; however, its clinical effectiveness in managing MCSS‐TCISCI has not been well‐established. This study aims to assess the clinical value of ODL‐BLMSF against MCSS‐TCISCI. Methods We retrospectively analyzed 20 cases of MCSS‐TCISCI treated with ODL‐BLMSF from July 2016 to June 2020. Radiographic alterations of all included patients were measured using plain radiographs, CT scans, and MRI scans. Cervical lordosis was evaluated using C2‐C7 Cobb angle and cervical curvature index (CCI) on lateral radiographs, and Pavlov ratio at the C5 level. Neurological functional recovery was assessed using Japanese Orthopaedic Association (JOA) scores and Nurick grade, while neck and axial symptoms were assessed using the neck disability index (NDI) and the visual analog scale (VAS). The paired t‐test was utilized for statistical analysis. Results All included patients were followed up for an average period of 26.5 months (range: 24–30 months) after ODL‐BLMSF. The average Pavlov ratio at the C5 level significantly improved from 0.57 ± 0.1 preoperatively to 1.13 ± 0.1 and 1.12 ± 0.04 at 6 months postoperatively and at the last follow‐up (t = 16.347, 16.536, p

Objectives: The prevalence of multi‐level cervical spinal stenosis complicated with traumatic cervical instability and spinal cord injury (MCSS‐TCISCI) is low, and the optimal surgical approach remains unclear. Open‐door laminoplasty combined with bilateral lateral mass screw fixation (ODL‐BLMSF) is a relatively new surgical technique; however, its clinical effectiveness in managing MCSS‐TCISCI has not been well‐established. This study aims to assess the clinical value of ODL‐BLMSF against MCSS‐TCISCI. Methods: We retrospectively analyzed 20 cases of MCSS‐TCISCI treated with ODL‐BLMSF from July 2016 to June 2020. Radiographic alterations of all included patients were measured using plain radiographs, CT scans, and MRI scans. Cervical lordosis was evaluated using C2‐C7 Cobb angle and cervical curvature index (CCI) on lateral radiographs, and Pavlov ratio at the C5 level. Neurological functional recovery was assessed using Japanese Orthopaedic Association (JOA) scores and Nurick grade, while neck and axial symptoms were assessed using the neck disability index (NDI) and the visual analog scale (VAS). The paired t‐test was utilized for statistical analysis. Results: All included patients were followed up for an average period of 26.5 months (range: 24–30 months) after ODL‐BLMSF. The average Pavlov ratio at the C5 level significantly improved from 0.57 ± 0.1 preoperatively to 1.13 ± 0.1 and 1.12 ± 0.04 at 6 months postoperatively and at the last follow‐up (t = 16.347, 16.536, p < 0.001). Importantly, this approach significantly increased the JOA score from 5.0 ± 2.6 before surgery to 11.65 ± 4.3 and 12.1 ± 4.3 at 6 months postoperatively and at the last follow‐up (t = 9.6, −9.600, p < 0.001), with an average JOA recovery rate of 59.1%; and the average Nurick disability score decreased from 3.0 ± 1.3 (preoperative) to 1.65 ± 1.22 and 1.5 ± 1.2 (6 months postoperatively and at last follow‐up) (t = 5.111, 1.831, p < 0.001). Meanwhile, the NDI score decreased from 30.3 ± 4.3 preoperatively to 13.2 ± 9.2 at 6 months (t = 12.305, p < 0.001), and to 12.45 ± 8.6 at the final follow‐up (t = 13.968, p < 0.001), while the VAS score decreased from 4.0 ± 1.5 preoperatively to 1.5 ± 0.7 at 6 months (t = 9.575, p < 0.001), and to 1.15 ± 0.7 at the final follow‐up (t = 10.356, p < 0.001). Conclusion: ODL‐BLMSF can effectively dilate the stenotic spinal canal to decompress the spinal cord, maintain good cervical alignment and stability, and improve the recovery of neurological function and neck function. This technique is suitable for treating selected cases of MCSS‐TCISCI. [ABSTRACT FROM AUTHOR]

Abstract Objective To investigate and evaluate the biomechanical behaviour of tension-band-reconstruction (TBR) and ordinary titanium plates in open-door laminoplasty by finite element (FE) analysis. Methods TBR titanium plate and ordinary titanium plate were implanted into a validated finite element model of healthy adult cervical vertebrae. Among them, 5 ordinary titanium plate were used in model A, 2 TBR titanium plates and 3 ordinary titanium plates were used in model B, and 5 TBR titanium plates were used in model C. The same loading conditions was applied identically to all models. Range of motion (ROM) of the vertebral body, stress distribution of the titanium plate and intradiscal pressure (IDP) were compared in flexion, extension, lateral bending and rotation. Results The ROM of model B and C was similar in flexion and extension, and both were smaller than that of model A. The highest von Mises stress in the titanium plate appears is in model C. The IDP in C2/3 was significantly higher than that in other segments in flexion. There was no significant difference in IDP among three models in left lateral bending and left axial rotation. Conclusion Application of TBR titanium plate in open-door laminoplasty can reduced ROM in flexion, extension and axial rotation of the cervical vertebrae. But the increase of stress in TBR titanium plate could lead to higher risk of adverse events such as titanium plate deformation. Moreover, compared with complete TBR titanium plate, the combination of TBR titanium plate for C3 and C7 with ordinary titanium plate for the other vertebrae largely reduce the stress of the titanium plates by ensuring stability. The proposed FE model (C2-T1) exhibits a great potential in evaluating biomechanical behaviour of TBR titanium plate for open-door laminoplasty.

Open-door laminoplasty is widely used for patients with cervical spondylotic myelopathy (CSM). However, the loss of cervical lordosis (LCL) seems to be unavoidable in the long-term follow-up after surgery, which may affect the clinical outcomes. The risk factors for this complication are still unclear. In this study, patients who underwent open-door laminoplasty between April 2016 and June 2021 were enrolled. Cervical X-rays were obtained to measure the C2–7 Cobb angle, C2–7 sagittal vertical axis (SVA), T1 slope (T1S) and ranges of motion (ROM). Cervical computed tomography (CT) scans and magnetic resonance imaging (MRI) were collected to evaluate the cervical Hounsfield unit values (HU) and the relative cross-sectional area (RCSA) of paraspinal muscles, respectively. A total of 42 patients were included and the average follow-up period was 24.9 months. Among the patients, 24 cases (57.1%) had a LCL of more than 5° at a 1-year follow-up and were labeled as members of the LCL group. The follow-up JOA scores were significantly lower in the LCL group (13.9 ± 0.6 vs. 14.4 ± 0.8, p = 0.021) and the mean JOA recovery rate was negatively correlated with LCL (r = −0.409, p = 0.007). In addition, LCL was positively correlated to the preoperative T1S, flexion ROM, flexion/extension ROM and the RCSA of flexion/extension muscles, while it was negatively correlated to extension ROM and the HU value of cervical vertebrae. Furthermore, multiple linear regression showed that preoperative T1S, mean HU value of cervical vertebrae, flexion/extension ROM and the flexion/extension RCSA were independent risk factors for LCL. Spine surgeons should consider these parameters before performing open-door laminoplasty. [ABSTRACT FROM AUTHOR]

Abstract Background During open-door laminoplasty, the position of the bone gutter is not fixed, and when the gutter migrates inward, the outer end of the titanium plate must be fixed on the lamina edge. It is unclear whether this will affect the clinical efficacy. This study aimed to observe the influence of the titanium plate fixation position on the effectiveness of open-door laminoplasty for cervical spondylotic myelopathy (CSM). Methods A total of 98 patients with CSM who underwent open-door laminoplasty from August 2016 to October 2019 were included in this retrospective study. Fifty-five patients had the titanium plate fixed on the lateral mass (lateral mass group), and 43 patients had the titanium plate fixed on the lamina edge (lamina group). The opening angle, opening width, occurrence of hinge fracture, spinal cord drift distance, cervical curvature index (CCI), neurological function recovery (JOA score), neck function (NDI), C5 palsy and severity of axial symptoms were observed and compared between the two groups. Results The opening angle in the lamina group was significantly larger than that in the lateral mass group, while the opening width and the spinal cord drift distance were significantly smaller than those in the lateral mass group (P 0.05), and there was no significant difference between the groups (P > 0.05). After surgery, the JOA score significantly increased in both groups (P

Four-level cervical spondylotic myelopathy (CSM) is a common disease affecting a large number of people, with the optimal surgical strategy remaining controversial. This study compared the clinical outcomes, radiological parameters, and postoperative complications of primarily performed surgical procedures such as anterior cervical discectomy and fusion (ACDF), open-door laminoplasty (LAMP), and laminectomy with fusion (LF) in treating four-level CSM. A total of 116 patients who received ACDF (38 cases), LAMP (45 cases), and LF (33 cases) were followed up for a minimum of 24 months were enrolled in this study and retrospectively analyzed. Clinical outcomes were evaluated using the Japanese Orthopedic Association (JOA) scoring system, the Neck Disability Index (NDI), and the Visual Analogue Scale (VAS). Changes in the curvature of the cervical spine were determined using the cervical curvature index (CCI) and the C2–C7 Cobb angle. Cervical mobility was evaluated using the C2–C7 range of motion (ROM) and active cervical ROM (aROM). Complications were recorded and compared among the three groups. All patients achieved significant improvement in JOA, NDI, and VAS scores at the final follow-up (P 0.05). In addition, both C2–7 ROM and aROM were significantly reduced in the three groups and LAMP showed the least reduction relatively. As for complications, LAMP showed the lowest overall incidence of postoperative complications, and patients in the ACDF group were more susceptible to dysphagia, pseudoarthrosis than LAMP and LF. Considering improvements in clinical symptoms and neurological function, no remarkable difference was found among the groups. Nevertheless, LAMP had advantages over the other two surgical procedures in terms of preserving cervical mobility and reducing postoperative complications.

ObjectiveTo compare the clinical efficacy and radiological outcomes of 3-level anterior cervical discectomy and fusion (ACDF) and open-door laminoplasty (LP).MethodsA total of 74 patients from January 2017 to January 2020 were enrolled in this retrospective study. There were two groups. Group A (30 cases) received 3-level ACDF, while Group B (44 cases) received open-door LP. Clinical evaluation included perioperative parameters, Neck Disability Index (NDI), and Japanese Orthopaedic Association (JOA) scores. Radiological evaluation included cervical curve depth (CCD), C2–7 angle, C2–7 sagittal vertical axis (cSVA), C7 slope (C7S), and T1 slope (T1S).ResultsPerioperative parameters such as blood loss, drainage volume after surgery, and hospital stay of patients in Group A were significantly less than those in Group B (P

Objective This study is to introduce lift‐open laminoplasty and verify the increase of the spinal canal area following this surgical technique according to the preoperative anatomical measurement. Methods There are 82 patients (43 male and 39 female) analyzed in our study from January 2019 to December 2020. The average age was 63.2 ± 3.21 years (from 41 to 84 years). All of them were treated with open‐door laminoplasty, with a decompression segment range from C3 to C6. The increase of the spinal canal area after open‐door laminoplasty was measured on postoperative CT images of the patients, and the distances between both lamina‐facet junctions and lamina length was measured on preoperative CT images. Using the Pythagorean theorem for the equation of calculation area after the expansile open‐door laminoplasty. Based on previous measurement parameters, spinous process length, lateral mass width, distance between osteotomy line and lamina‐facet junctions line were additionally measured on preoperative CT images. Pythagorean theorem was used for calculating the area after the expansile lift‐open laminoplasty. The results were recorded and a statistical analysis was undertaken. Then, there were six patients (five male and one female) treated with lift‐open laminoplasty on C6, open‐door on C3–C5, who suffer from cervical spondylotic myelopathy from December 2020 to January 2021. The average age was 60.3 ± 1.7 years (from 56 to 71 years). Operation time, blood loss, and Japanese Orthopaedic Association (JOA) score recovery rate were recorded. Intraoperative and postoperative complications were observed. Results The increase of the spinal canal area after open‐door laminoplasty measured on postoperative CT images was 123.01 ± 17.06 mm2 and the calculation of the increase of the spinal canal areausing the Pythagorean theorem after open‐door laminoplasty was 122.86 ± 15.86 mm2. A comparison of the actual value with calculative value showed no significant difference (T value = 0.057, P value = 0.955). The calculation of the increase of the spinal canal area after lift‐open laminoplasty was 183.57 ± 62.99 mm2, which was larger than that after open‐door laminoplasty (T value = 8.462, P value

In order to solve the problem of hinge fracture with laminae displacement during open door laminoplasty, several treatment methods were investigate for the postoperative clinical efficacy. A total of 319 patients with cervical spondylotic myelopathy accepted open-door laminoplasty and titanium plate fixation in Handan central hospital from May 2013 to September 2018 were retrospective analyzed, among of them, 63 patients occurred hinge fracture with laminae displacement. Patients were divided into two groups according to the treatment methods. Reconstruction group (35 cases) accepted imbricate reconstruction combined with titanium plate fixation, and resection group (28 cases) accepted lamina resection. The intraoperative indicators were recorded and compared. The neurological function (JOA score), cervical curvature index (CCI), cross sectional area of posterior cervical muscles and axial symptoms were observed. The results show that there was no significant difference in terms of operative time and bleeding volume between the two groups (P > 0. 05). The cross-sectional area of the posterior cervical muscles in both groups was significantly reduced compared with the preoperative level (P < 0. 05), but the decline degree in reconstruction group was significantly lower than that in the resection group (P <0. 05). The CCI in the reconstruction group was maintained well after surgery (P > 0. 05), but in resection group, it was significantly lost (P <0. 05). The JOA scores in both groups was significantly increased after surgery (P <0. 05), and there was no significant difference between the groups at different time point (P > 0. 05). The occurrence of axial symptoms was 8. 6% (3/35) in reconstruction group and 21. 3% (6/28) in resection group (P <0. 05). The hinge fusion rate at 3 and 6 months after surgery was 81. 6% (31/38) and 94. 7% (36/38), respectively. It is concluded that, for patients with hinge fracture and laminar displacement, imbricate reconstruction combined with titanium plate fixation will not affect the recovery of neurological function, but hinge reconstruction is more conducive to the maintain the cervical curvature and reduce the atrophy of the posterior muscles, thereby reducing the occurrence of axial symptoms. [ABSTRACT FROM AUTHOR]

Background: During open-door laminoplasty, the position of the bone gutter is not fixed, and when the gutter migrates inward, the outer end of the titanium plate must be fixed on the lamina edge. It is unclear whether this will affect the clinical efficacy. This study aimed to observe the influence of the titanium plate fixation position on the effectiveness of open-door laminoplasty for cervical spondylotic myelopathy (CSM). Methods: A total of 98 patients with CSM who underwent open-door laminoplasty from August 2016 to October 2019 were included in this retrospective study. Fifty-five patients had the titanium plate fixed on the lateral mass (lateral mass group), and 43 patients had the titanium plate fixed on the lamina edge (lamina group). The opening angle, opening width, occurrence of hinge fracture, spinal cord drift distance, cervical curvature index (CCI), neurological function recovery (JOA score), neck function (NDI), C5 palsy and severity of axial symptoms were observed and compared between the two groups. Results: The opening angle in the lamina group was significantly larger than that in the lateral mass group, while the opening width and the spinal cord drift distance were significantly smaller than those in the lateral mass group (P < 0.05). The occurrence of hinge fracture in the lamina group was significantly higher than that in the lateral group (25.6% and 9.1%, respectively) (P < 0.05). The CCI was maintained well in both groups (P > 0.05), and there was no significant difference between the groups (P > 0.05). After surgery, the JOA score significantly increased in both groups (P < 0.05), and the neurological recovery rates were similar between the two groups (62.6% vs. 64.5%). The NDI score significantly decreased in both groups (P < 0.05), but the lateral mass group recovered to a greater degree than the lamina group (P < 0.05). The occurrence of C5 palsy was 2.3% in the lamina group and 14.5% in the lateral mass group, and there was a significant difference between the groups (P < 0.05). Postoperative axial symptom severity was significantly worse in the lamina group than in the lateral mass group (P < 0.05). Conclusions: In open-door laminoplasty, it is feasible to fix the titanium plate on the lateral mass or to the lamina due to the same neurological function recovery. However, fixing it to the lamina will increase the opening angle and decrease the opening width, making the hinge prone to fracture and increasing the severity of postoperative axial symptoms. [ABSTRACT FROM AUTHOR]

Abstract Background The open-door laminoplasty is an effective procedure for the treatment of cervical spondylotic myelopathy. However, little information is available about the surgical results of open-door laminoplasty in the treatment of intraspinal tumors. In the present study, we aimed to investigate the clinical effect of open-door laminoplasty with ARCH plate fixation in the treatment of cervical intraspinal tumors. Methods This was a retrospective study. From January 2013 to May 2018, 38 patients (13 males and 25 females, the average age of 44 ± 17 years) with cervical intraspinal tumors underwent open-door laminoplasty with ARCH plate fixation in our hospital. The operation time, blood loss, pre- and postoperative visual analog scale (VAS), and Japanese Orthopedic Association (JOA) scores were determined. To determine the radiographic outcomes, cervical X-ray film and magnetic resonance imaging (MRI) were performed before and after the operation, and cervical X-ray sagittal film was used to measure Cobb angle. The clinical data before and after the operation were compared by t-test. Results A total of 38 patients underwent a successful operation and demonstrated primary healing. The average operation time was 113 ± 12 min. The average blood loss was 120 ± 19 mL. All patients were followed up for 26.1 ± 2.8 months, and the final follow-up time was more than 24 months. VAS scores were much better at 24 months after operation compared with those before the operation, which were decreased from 6.1 ± 1.1 to 1.4 ± 0.7 (t = 32.63, P 0.05). Neither spinal malalignment on the coronal plane nor displacement of the laminoplasty flap was observed on postoperative cervical X-ray and MRI examinations at the final follow-up. Conclusions Open-door laminoplasty with ARCH plate fixation was a safe and effective surgical approach for the treatment of cervical intraspinal tumors.

BACKGROUND: Open-door laminoplasty is the most commonly used posterior cervical decompression surgery. The volume change of cervical herniated disc has always been a hot topic. It has been reported the phenomenon of resorption of herniated nucleus pulposus after open-door laminoplasty. However, most of these observations are qualitative studies. There is no literature on the quantitative observation of postoperative cervical herniated disc volume by threedimensional volume method. OBJECTIVE: To compare and analyze the changes of cervical herniated disc volume after open-door laminoplasty and conservative treatment. METHODS: The data of 61 patients who underwent open-door laminoplasty and 63 patients who received conservative treatment in the Department of Orthopedics, First Affiliated Hospital of Zhengzhou University from 2014 to 2020 were collected retrospectively. Three-dimensional volume method was used to measure the cervical herniated disc volume of the two groups at the first time before treatment and the last follow-up after treatment. The consistency of the measurement results was tested and the changes were analyzed. The interval between two measurements of all patients was at least 3 months. The absorption ratio and absorption rate, re-protrusion ratio and re-protrusion rate of cervical herniated disc were used as the measurement results. When the absorption rate of herniated cervical intervertebral disc was greater than 5.00% (or the re-protrusion rate was less than -5.00%), it is considered that the cervical herniated disc experienced absorption (or re-herniation). RESULTS AND CONCLUSION: (1) Changes in cervical herniated disc volume in the open-door group: There were 176 cervical herniated discs in 61 patients. Among them, 96 cervical herniated discs were absorbed; the absorption ratio was 54.6% (96/176), and the absorption rate was 5.0%-55.2%. In addition, 46 cervical herniated discs were re-protruded; the ratio of re-protrusion was 26.1% (46/176), and the re-protrusion rate was -5.9% to -77.9%. There was no change in the volume of the other 34 cervical herniated discs. According to the Odom criteria, the results were excellent in 17 cases and good in 28 cases, and the excellent and good rate was 73.8% (45/61). (2) Changes in cervical herniated disc volume in the conservative treatment group: There were 171 cervical herniated discs in 63 patients. Among them, 55 cervical herniated discs were absorbed; the absorption ratio was 32.2% (55/171), and the absorption rate was 5.3%-50.7%. Another 83 cervical herniated discs were re-protruded, with a re-protrusion ratio of 48.5% (83/171), and a re-protrusion rate of -5.4% to -219.8%. There was no change in the volume of the other 33 cervical herniated discs. According to the Odom criteria, the results were excellent in 12 cases and good in 21 cases, and the excellent and good rate was 52.4% (33/63). (3) Three-dimensional volume measurement was an accurate method to observe cervical herniated disc (ICC=0.818). In the open-door group, 6 patients showed varying degrees of re-protrusion of all cervical herniated discs; 13 patients showed resorption of herniated nucleus pulposus; 6 patients showed volume unchanged, and the remaining 36 patients showed the coexistence of those three phenomena. In the conservative treatment group, 32 patients showed varying degrees of re-protrusion in all cervical herniated discs; 5 patients showed resorption of herniated nucleus pulposus; and 7 patients showed volume unchanged, the remaining 19 patients showed the coexistence of the three phenomena. (4) It is concluded that three-dimensional volume method is an accurate and reliable method to observe the changes of cervical herniated disc volume after open-door laminoplasty. Half of the cervical herniated disc after open-door laminoplasty showed slight reduction, which was easy to be ignored, and a few showed moderate and severe re-protrusion, which may lead to further progression of symptoms, indicating that open-door laminoplasty is an effective surgical intervention, but there is a risk of cervical herniated disc re-protrusion, which needs to be further improved. [ABSTRACT FROM AUTHOR]

Study Design: A case-control study.Objectives: The aim of this study was to evaluate the outcomes of two modified laminoplasties (LPs) based on a novel paraspinal approach for treating multilevel cervical spondylotic myelopathy.Summary Of Background Data: No laminoplasty through a natural intermuscular plane mimicking Wiltse approach to minimize intraoperative injury to extensor muscles has ever been developed and studied.Methods: Ninety-two patients were enrolled, including patients treated with either modified LP and patients treated with concurrent conventional LP. Operation time, blood loss, and complications were recorded. Clinical outcomes were evaluated by VAS, JOA scores, and recovery rate. Cervical sagittal alignment was measured on cervical radiographs. Spinal canal expansion was assessed on CT scans. Cross-sectional area (CSA) and atrophy rate (AR) of cervical deep extensors were evaluated on MRI.Results: The average follow-up duration was 33.05, 31.55, 33.02, and 32.52 months, respectively in each group. Compared to concurrent conventional procedure, unilateral muscle-preserving procedure displayed similar, whereas bilateral muscle-preserving procedure showed significantly increased operation time and blood loss; each modified procedure resulted in comparable and satisfied perioperative clinical scores, spinal canal expansion while achieving significantly lower axial pain incidence, better cervical lordosis maintenance, and better deep extensor preservation. AR of deep extensors on the open side was significantly lower than that on the hinge side. Bilateral paraspinal approach demonstrated significantly better muscle-preservation on the open side and increased operation duration, with similar clinical scores, axial pain incidence, cervical lordosis maintenance, and spinal canal expansion compared to unilateral paraspinal approach. Loss of cervical lordosis was strongly correlated with AR of deep extensors.Conclusion: Paraspinal approach is a good manner to protect deep extensor muscles; the two modified LPs have similar effects on clinical outcomes.Level of Evidence: 3. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the comparative effectiveness and safety of open-door laminoplasty (OLP), French-door laminoplasty (FLP), laminectomy and fusion (LF), and laminectomy alone (LA) in treating multilevel degenerative cervical myelopathy (MDCM). Methods: Embase, PubMed, and Cochrane library were searched from their inception date to 7 January 2021. Randomized controlled trials and cohort studies comparing OLP, FLP, LF, and LA were identified to perform a network meta-analysis (NMA). Results: A total of 30 studies with 2671 patients were included. Our NMA results showed no significant difference between LF and OLP, but both are superior to LA and FLP in the comparison of JOA (Japanese Orthopaedic Association) score improvement. LF showed a most unsatisfactory outcome in postoperative range of motion (ROM) compared with LA or OLP or with FLP. For the complication outcome, no significant differences were found. The surface under the cumulative ranking curves (SUCRA) for JOA improvement was as follows: LF, OPL, LA, and FLP. For ROM reduction it was LA, OPL, FPL, and LF. For complications it was LF, LA, OLP, and FLP. Conclusions: Considering all the evaluated criteria, none of the procedures showed the best outcome with least complications and optimal efficacy. However, OLP can be most recommended because of its second-ranking spectra in both of JOA improvement and ROM reduction, also with an acceptable incidence of complications, with the third least. [ABSTRACT FROM AUTHOR]

BACKGROUND: Cervical spondylotic myelopathy causes spinal canal stenosis and spinal cord dysfunction through direct or indirect compression of the spinal cord or surrounding blood vessels. Posterior cervical laminoplasty for cervical spondylotic myelopathy is effective and widely used in clinical practice. OBJECTIVE: To evaluate the repair effect of modified open-door laminoplasty with preserved posterior cervical musculo-ligamentous complex in the treatment of cervical spondylotic myelopathy. METHODS: Medical record data of 126 patients with cervical spondylotic myelopathy from Tianyou Hospital Affiliated to Wuhan University of Science & Technology from June 2015 to July 2018 were retrospectively analyzed. They were assigned to two groups according to the surgical program. The 72 patients in the modified group received modified open-door laminoplasty with preserved posterior cervical musculo-ligamentous complex. The 54 patients in the control group received traditional vertebral plate keratoplasty. Baseline data, operation time, intraoperative blood loss, cervical curvature index, range of motion, and posterior cervical volume were compared between the two groups. Japanese Orthopaedic Association Scores, visual analogue scale scores, and Neck disability index were recorded before surgery, 24 months after surgery, and during final follow-up. The incidence of complications was recorded after surgery. RESULTS AND CONCLUSION: (1) The last follow-up showed that the cervical curvature rate, range of motion, and cervical curvature index in the modified group were better than those in the control group (P < 0.01). (2) Compared with the control group, visual analogue scale score and Neck disability index were significantly lower in the modified group (P < 0.01). (3) The body volume on the hinge side in the modified group was not significantly different from that before surgery, but it was significantly increased compared with the control group (P < 0.01). (4) In addition, the incidence of axial symptoms in the modified group was significantly lower than that in the control group (6% vs. 22%), and the difference was statistically significant (P < 0.05). (5) It is suggested that modified open-door laminoplasty with posterior cervical musculo-ligamentous complex is an effective method for the treatment of cervical spondylotic myelopathy. The patient’s neurological function recovered well, and the curvature and range of motion of cervical vertebra were well maintained. Moreover, it reduced the incidence of postoperative axial symptoms compared to traditional open-door laminoplasty. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the superiority of open-door versus French-door posterior cervical laminoplasty in the treatment of multisegmental cervical spondylotic myelopathy by comparing the intraoperative parameters and clinical and radiologic outcomes of these 2 procedures. PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, the Wanfang database, the Weipu database, and China Biology Medicine disk were searched. Articles were retrieved from database establishment through May 22, 2020. Data analysis was carried out on the retrieved articles using RevMan 5.3 software. This meta-analysis included 14 studies involving 1010 patients, among which 6 were randomized controlled trials and 8 were retrospective analyses. Comparing the open-door and French-door groups, no statistically significant differences were found in operative time (weighted mean difference [WMD] = −4.47, 95% CI [−17.85, 8.92], P = 0.51), postoperative Japanese Orthopaedic Association score (WMD= −0.24, 95% CI [−0.87, 0.38], P = 0.45), recovery rate (WMD= −0.58, 95% CI [−3.61, 2.45], P = 0.71), postoperative cervical lordosis (WMD= −0.15, 95% CI [−1.93, 1.63], P = 0.87), cervical range of motion (WMD = −3.04, 95% CI [−8.68, 2.59], P = 0.29), sagittal diameter of the spinal canal (WMD = −0.24, 95% CI [−0.54, 0.07], P = 0.13), incidence of C5 palsy (OR = 1.78, 95% CI [0.64, 4.93], P = 0.27), or incidence of cerebrospinal fluid leakage (OR = 1.51, 95% CI [0.48, 4.71], P = 0.48). However, the French-door group was associated with less intraoperative bleeding (WMD = 54.96, 95% CI [21.37, 88.55], P = 0.001) and a lower incidence of axial symptoms (OR = 2.50, 95% CI [1.32, 4.72], P = 0.005). This analysis suggests that both methods can achieve good postoperative outcomes. However, less intraoperative bleeding and a lower incidence of postoperative axial symptoms were found in the French-door group. This requires further validation and investigation in larger sample-size and well-designed randomized controlled studies. [ABSTRACT FROM AUTHOR]

Abstract Background The present study evaluated the clinical outcomes and safety of expansive open-door laminoplasty, when securing with C4 – C6 lateral mass screw and fusion. Methods A total of 110 patients with cervical spondylotic myelopathy (CSM) were enrolled. There were 88 male and 22 female, with mean age at 60.55 ± 10.95 years. All of the patients underwent expansive open-door laminoplasty with unilateral or bilateral C4–6 lateral mass screws fixation and fusion. Clinical data, including age, gender, operation-related information, pre- and post-operation Japanese Orthopedic Association (JOA) scores, and cervical curvatures were collected. Results The mean follow-up time of the cohort was 13.61 ± 9.53 months. Among the 110 patients, 33 of them were allocated to Unilateral group, and 77 of them were in Bilateral group. The mean JOA score of the 110 patients before surgery was 10.07 ± 2.39, and the score was improved significantly to 12.85 ± 2.45 after surgery. There were no reported cases of neurological deterioration or symptom worsening. Patients in both the Unilateral group and Bilateral groups had significant improvement of JOA scores. Among all patients, the most frequently observed complications were axial symptoms (n = 7). The average preoperative cervical curvature among all patients was 15.17 ± 5.26, and the post-surgery curvature was 14.41 ± 4.29. Similar observations were found between Unilateral and Bilateral groups. Conclusion The modified surgical approach provided satisfactory clinical outcome in patients with CSM. The unilateral and bilateral fixation appeared to provide similar outcomes, in terms of cervical curvature maintenance and improvement of clinical symptoms. However, the examination of the exact differences between the two fixation methods await further biomechanical studies.

Objective: This study is to introduce lift‐open laminoplasty and verify the increase of the spinal canal area following this surgical technique according to the preoperative anatomical measurement. Methods: There are 82 patients (43 male and 39 female) analyzed in our study from January 2019 to December 2020. The average age was 63.2 ± 3.21 years (from 41 to 84 years). All of them were treated with open‐door laminoplasty, with a decompression segment range from C3 to C6. The increase of the spinal canal area after open‐door laminoplasty was measured on postoperative CT images of the patients, and the distances between both lamina‐facet junctions and lamina length was measured on preoperative CT images. Using the Pythagorean theorem for the equation of calculation area after the expansile open‐door laminoplasty. Based on previous measurement parameters, spinous process length, lateral mass width, distance between osteotomy line and lamina‐facet junctions line were additionally measured on preoperative CT images. Pythagorean theorem was used for calculating the area after the expansile lift‐open laminoplasty. The results were recorded and a statistical analysis was undertaken. Then, there were six patients (five male and one female) treated with lift‐open laminoplasty on C6, open‐door on C3–C5, who suffer from cervical spondylotic myelopathy from December 2020 to January 2021. The average age was 60.3 ± 1.7 years (from 56 to 71 years). Operation time, blood loss, and Japanese Orthopaedic Association (JOA) score recovery rate were recorded. Intraoperative and postoperative complications were observed. Results: The increase of the spinal canal area after open‐door laminoplasty measured on postoperative CT images was 123.01 ± 17.06 mm2 and the calculation of the increase of the spinal canal areausing the Pythagorean theorem after open‐door laminoplasty was 122.86 ± 15.86 mm2. A comparison of the actual value with calculative value showed no significant difference (T value = 0.057, P value = 0.955). The calculation of the increase of the spinal canal area after lift‐open laminoplasty was 183.57 ± 62.99 mm2, which was larger than that after open‐door laminoplasty (T value = 8.462, P value < 0.001). Mean operation time was 153.3 min and operative blood loss was 600 mL of the six patients treated with lift‐open laminoplasty. At 1 month follow‐up, all patients had recovered well. JOA score recovery rate was 37.6% and no intraoperative and postoperative complications occurred. Conclusion: Lift‐open laminoplasty could preserve nearly 100% of extensor muscle, avoid damaging C7 paraspinal muscles and C6‐7 posterior muscle‐ligament complex, reconstruct the spinous process firmly in the midline, and expand adequate spinal canal area after operation. These advantages could reduce the incidence rate of complications and bring better clinical results than traditional laminoplasty. [ABSTRACT FROM AUTHOR]

Background: The open-door laminoplasty is an effective procedure for the treatment of cervical spondylotic myelopathy. However, little information is available about the surgical results of open-door laminoplasty in the treatment of intraspinal tumors. In the present study, we aimed to investigate the clinical effect of open-door laminoplasty with ARCH plate fixation in the treatment of cervical intraspinal tumors.Methods: This was a retrospective study. From January 2013 to May 2018, 38 patients (13 males and 25 females, the average age of 44 ± 17 years) with cervical intraspinal tumors underwent open-door laminoplasty with ARCH plate fixation in our hospital. The operation time, blood loss, pre- and postoperative visual analog scale (VAS), and Japanese Orthopedic Association (JOA) scores were determined. To determine the radiographic outcomes, cervical X-ray film and magnetic resonance imaging (MRI) were performed before and after the operation, and cervical X-ray sagittal film was used to measure Cobb angle. The clinical data before and after the operation were compared by t-test.Results: A total of 38 patients underwent a successful operation and demonstrated primary healing. The average operation time was 113 ± 12 min. The average blood loss was 120 ± 19 mL. All patients were followed up for 26.1 ± 2.8 months, and the final follow-up time was more than 24 months. VAS scores were much better at 24 months after operation compared with those before the operation, which were decreased from 6.1 ± 1.1 to 1.4 ± 0.7 (t = 32.63, P < 0.01). The JOA score was improved from 9.9 ± 1.5 to 15.5 ± 0.6 (t = - 18.36, P < 0.01), and the mean JOA recovery rate was 79% ± 11% at 24 months after the operation. There was no significant difference in Cobb angle between pre-operation and 24 months after the operation, which was 9.8 ± 2.6 and 10.3 ± 3.1 respectively (t = - 0.61, P > 0.05). Neither spinal malalignment on the coronal plane nor displacement of the laminoplasty flap was observed on postoperative cervical X-ray and MRI examinations at the final follow-up.Conclusions: Open-door laminoplasty with ARCH plate fixation was a safe and effective surgical approach for the treatment of cervical intraspinal tumors. [ABSTRACT FROM AUTHOR]

Background and Study Aim Cervical spondylotic myelopathy (CSM) is a common degenerative disease that mainly occurs in elder patients, leading to different degrees of neurological dysfunction. Spinal cord involvement is mainly distributed at the C3–C7 segments, but it may also involve up to the C2 level. This study aimed to assess the clinical efficacy and safety of open-door laminoplasty using a new extensor attachment-point reconstruction technique for treating CSM involving the C2 segment. Patients and Methods Fifty-nine patients with CSM involving the C2 segment and undergoing open-door laminoplasty were included in this retrospective study. Based on the titanium plate used in the operation, patients were divided into two groups, a reconstructed titanium plate fixation (RPF) group (n = 28) and a conventional titanium plate fixation (CPF) group (n = 31). Improvements in neurological function, cervical range of motion (ROM), cervical curvature index (CCI), preservation of posterior cervical muscle mass, and axial symptoms were compared between the two groups. Results There were no significant differences in operative time and intraoperative blood loss between the groups (p > 0.05). The Japanese Orthopaedic Association (JOA) score significantly increased in both groups postsurgery (p < 0.05); the neurological recovery rate was similar between the two groups (64.1 ± 13.3% vs. 65.9 ± 14.7%, p > 0.05). There was no significant loss of cervical ROM in either group (p > 0.05). The anteroposterior dural sac diameter at the C2 level was significantly enlarged in both groups (p < 0.05). Alternatively, CCI was significantly reduced in the CRP group (p < 0.05) but unchanged in the RPF group (p > 0.05). The cross-sectional area of the posterior cervical muscles was also significantly reduced in the CPF group (p < 0.05) but maintained in the RPF group (p > 0.05). Finally, axial symptoms were more severe in the CPF group than in the RPF group (p < 0.05). Conclusion Laminoplasty is an effective surgical procedure for CSM involving the C2 segment. The reconstructed titanium plate achieved superior maintenance of cervical curvature and reduced both muscle atrophy and severity of axial symptoms compared with titanium conventional plates. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective cohort study., Objective: This study aimed to compare postoperative pain and surgical outcomes of open-door laminoplasty (LP) and three types of muscle-sparing laminoplasties, namely unilateral muscle-preservation laminoplasty (UL), spinous process splitting double-door laminoplasty (DL) and intermuscular "raising roof" laminoplasty (RL) for multilevel degenerative cervical myelopathy (MDCM)., Methods: Consecutive MDCM patients underwent LP or modified laminoplasties (UL, DL, RL) in 2022 were enrolled. Patients' preoperative baseline data and surgical characteristics were collected. Postoperative transient pain (TP), the axial pain and Japanese Orthopedic Association (JOA) score and neck disability index (NDI) at 6-month and 12-month follow-up were documented., Results: A total of 154 MDCM patients were included and a 12-month follow-up was completed for 148 patients (LP: 36, UL:39, DL: 37, RL:36). No significant difference was observed in the baseline data. Four groups presented favorable and comparable surgical outcome. The RL group reported significantly the least severe TP on the first three days following surgery. However, no significant difference was found in the axial pain and axial symptoms at both follow-ups. After regression analysis, RL group exhibited significantly better efficacy in alleviating Day-1 TP ( P = 0.047) and 6-month axial pain ( P = 0.040). However, this superiority was not observed at 12-month follow-up., Conclusion: All the three muscle-sparing laminoplasty procedures showed similar short-term surgical outcomes compared to LP. The RL procedure demonstrated superiority in alleviating TP and 6-month axial pain compared to LP. The RL and DL groups showed less C5 palsy compared to LP., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: We reviewed the literature comparing the indications/efficacy of laminectomy (LA) with or without fusion versus laminoplasty (LP) in the treatment of cervical spondylotic myelopathy (CSM). Methods: We identified 14 studies in PubMed/Medline to include in our analysis. Outcomes were assessed utilizing the Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS), Neck Disability Index, and Nurick scale. Variables studied included ossification of the posterior longitudinal ligament (OPLL), cervical range of motion (ROM), the C2-C7 sagittal Cobb angle, the Ishihara index, and the Hirabayashi scale. Patients with cervical trauma/fracture, infection, or tumor were excluded from the study. Results: In these 14 studies, there were no significant differences between LA and LP groups in terms of preoperative versus postoperative: JOA scores (e.g., including the improvement rate), VAS scores, and ROM. However, the LA patients demonstrated greater postoperative cervical lordosis versus those in the LP group. Conclusion: At present, there are no guidelines for choosing LA versus LP for treating CSM. Factors that should be considered when choosing one procedure over the other should include the patients' preoperative clinical status, the type of CSM, the pathological extent of OPLL, and whether there is a sufficient cervical lordotic curvature. [ABSTRACT FROM AUTHOR]

Background Context: Open-door laminoplasty often results in postoperative complications such as loss of cervical lordosis, limitations of cervical motion, and axial symptoms. However, current modified laminoplasty techniques such as muscle-sparing type or spinous process splitting technique are not as effective as expected.Purpose: To evaluate the radiological and clinical outcomes of C3 laminectomy combined with modified unilateral laminoplasty (preservation of posterior muscle-ligament complex and reconstruction of the midline structures) versus traditional open door laminoplasty in treating cervical spondylotic myelopathy or ossification of the posterior longitudinal ligament.Study Design: Retrospective case-control study.Patient Sample: One hundred and eleven patients with multilevel cord compression and myelopathic symptoms.Outcome Measures: The outcome parameters were operation time, blood loss volume, complications, osseous fusion status, C0-C2 and C2-C7 Cobb angles, T1 slope, cervical sagittal vertical axis (cSVA), cervical curvature index (CCI), range of motion (ROM), cross-sectional area (CSA) of the semispinalis cervicis, axial symptoms, visual analog scale (VAS) score, Japanese Orthopedic Association (JOA) score, and neck disability index (NDI).Methods: We matched 37 patients who underwent modified laminoplasty with 74 patients treated by traditional open door laminoplasty (ratio, 1:2) according to age, sex, body mass index, compromised level, and radiographic characteristics. Preoperative and postoperative cervical parameters, namely, the C2-C7 Cobb angle, ROM, and CCI were measured on X-ray films. The CSA of the semispinalis cervicis was assessed on magnetic resonance images, and osseous fusion status of the hinge side and the osteotomy site was evaluated by computed tomography. We used the JOA and VAS scores, and the NDI to evaluate clinical outcomes.Results: The average follow-up period in the modified group was 24.1 months (range, 18-37 months) compared with 24.7 months (range, 18-38 months) in the control group. At the final follow-up, C0-C2 Cobb angle, T1 slope, and cSVA increased in the control group and were unchanged in the modified group. The C2-C7 Cobb angle decreased significantly in the control group and did not change in the modified group. ROM and CCI loss rate did not change in the modified group but decreased significantly in the control group. The CSA loss in the semispinalis cervicis was 222.90±79.56 mm2 in the control group and 49.11±75.93 mm2 in the modified group, with a significant difference (p<.001). The final CSA of the semispinalis cervicis at C2 and C4-C7 levels showed no significant difference in the modified group and decreased significantly in the control group compared with preoperation. Changes in the C2-C7 Cobb angle and cSVA were both correlated with the CSA loss of the semispinalis cervicis (r=0.282, p=.003; r=0.267, p=.005, respectively). Moreover, the CSA loss of the semispinalis cervicis also correlated with the CCI loss rate and the changes in ROM (r=0.312, p=.001; r=0.287, p=.002, respectively). Clinical outcomes such as VAS and NDI scores, improved significantly more in the modified group versus the controls (p<.001 and p=.005, respectively), while JOA scores improved similarly in both groups (p=.132). The incidence of axial symptoms was significantly lower in the modified group versus controls (5.4% vs 9.5%, respectively; p=.023).Conclusions: C3 laminectomy combined with modified unilateral laminoplasty is effective for treating patients with multilevel cord compression. This modified technique reconstructs the midline structures and may lead to improved alignment and less axial pain. [ABSTRACT FROM AUTHOR]

• Cervical vertebra laminoplasties with straight- and curved-cut hinges were compared. • Modeling and experimental results indicate curved-cut hinges more failure resistant. • New curved-cut technique potentially lowers risk of hinge fracture and displacement. In this study, the stabilities of the hinge sides of plate-augmented open-door laminoplasties based on cutting in a curved or straight line were compared using a finite element (FE) model and an experimental assessment. Using FE models generated from CT scans of a human subject, straight and curved techniques for cutting the hinge side were evaluated. Compressive forces were applied to both simulated models, and the stress distributions on the respective hinge sites were evaluated by comparing the maximum von Mises stresses. Biomechanical testing procedures were then carried out on porcine cervical vertebrae, with straight- and curved-cut groups loaded to failure, and the corresponding reaction forces on the hinge sites were recorded using a loading cell. The FE analysis results revealed no significant differences between the straight- and curved-cut groups in terms of maximum stress forces on the superior, middle, or inferior portions of the hinge sites. In the experimental study, the curved-cut group withstood higher loads to failure at the hinge site than the straight-cut group. The ability of the curved-cut laminoplasty hinges to withstand higher compressive loading to failure than straight-cut hinges suggests the potential of the proposed technique to reduce the risk of hinge fracture and displacement. [ABSTRACT FROM AUTHOR]

To investigate the noninferiority of facet joint- and nuchal ligament-sparing laminectomy (FNL) compared with conventional open-door laminoplasty. This retrospective study analyzed 31 patients who underwent FNL (7 women; median age, 71 years) and 29 patients who underwent laminoplasty (9 women; median age, 61 years) with cervical myelopathy due to degenerative cervical spine diseases. The surgical concept in laminectomy was to spare the facet joints and nuchal ligament, providing laminectomy with deviation to the side of dominant symptoms. In both groups, recovery rate of Japanese Orthopaedic Association (JOA) score, mean decompression ratio (decompressed width/distance between outermost edges of the lateral mass on computed tomography ×100) at decompressed laminas, and pre- and postoperative final cervical Cobb angle and cervical sagittal vertical axis were mainly examined. Clinical and radiologic median data with interquartile range for patients who underwent FNL and laminoplasty were as follows: postoperative follow-up, 783.0 days (535.0–1128.0 days) and 731.0 days (524.0–1213.5 days); preoperative JOA score (full score 17), 13.0 (9.5–15.0) and 13.0 (10.0–14.0); recovery rate of JOA score, 72.2% (33.3–100.0%) and 50.0% (31.0–75.0%); and mean decompression ratio, 41.9% (40.0–43.6%) and 51.6% (48.9–55.4%), respectively. The FNL group showed a comparable recovery rate of JOA score to the laminoplasty group, despite the significantly smaller mean decompression ratio (P < 0.001). Furthermore, no significant differences in pre- or postoperative median cervical Cobb angle or sagittal vertical axis were observed between groups. FNL was not inferior to conventional open-door laminoplasty in terms of clinical or radiologic outcomes, reducing the detachment of muscle from each lamina. [ABSTRACT FROM AUTHOR]

MINI: The surgical results of modified and traditional open-door laminoplasties were retrospectively compared. There were no differences in neurological outcomes and postoperative complications. However, compared with traditional laminoplasty, modified laminoplasty was associated with better maintenance of cervical curvature and ROM, as well as a lower incidence of postoperative axial symptoms.Study Design: A retrospective comparative study.Objective: The aim of this study was to evaluate the efficacy of modified unilateral open-door laminoplasty with posterior muscle-ligament complex preservation in treating cervical spondylotic myelopathy (CSM).Summary Of Background Data: The prevalence of axial symptoms after open-door laminoplasty ranges from 5% to 86%. Current modified laminoplasty techniques cannot satisfactorily reduce postoperative axial symptoms.Methods: From June 2014 to July 2016, 36 patients with CSM underwent modified laminoplasty with posterior muscle-ligament complex preservation (modified group) and 27 patients underwent traditional laminoplasty (control group). The demographics, operation duration, blood loss volume, cervical curvature, cervical curvature index (CCI), range of motion (ROM), cervical posterior muscle volume on magnetic resonance imaging (MRI), axial symptoms, visual analog scale (VAS) score, Japanese Orthopedic Association (JOA) score, neck disability index (NDI), and complications were recorded and analyzed before operation, after operation, and at the final follow-up.Results: Cervical flexion curvature, cervical curvature, ROM, and CCI were better in the modified group than in controls at the final follow-up (P < 0.01). Postoperative VAS and NDI scores were significantly reduced in the modified group compared with controls (1.15 ± 0.76 vs. 2.63 ± 1.06, 5.67 ± 2.57 vs. 8.89 ± 5.37, respectively) (P < 0.01). Posterior muscle volume at the hinge side in the modified group was not different at final follow-up relative to that before the operation, whereas it was reduced in controls (P < 0.01). Finally, the incidence of axial symptoms was significantly lower in the modified group than in controls (6% vs. 22%) (P = 0.03).Conclusion: Modified unilateral open-door laminoplasty with posterior muscle-ligament complex preservation is effective for treating CSM with good recovery of neurological functions and satisfactory maintenance of cervical curvature and ROM. Furthermore, it reduces the incidence of postoperative axial symptoms compared with conventional open-door laminoplasty.Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]

• Mini plate can be used as alternative material for laminoplasty procedures. • Modified spacer for laminoplasty is needed in case of the conventional one is not available. • Posterior cervical laminoplasty decompression is important issue to investigate. Cervical spondylotic myelopathy (CSM) is a complex disease that presents with various signs and symptoms of cervical spinal cord impairment that may lead to significant clinical morbidity. We present the case of a 50-year old man who was diagnosed with CSM. The patient underwent decompression and posterior stabilisation with open-door laminoplasty. At the 2-month follow-up, the pain subsided, function improved significantly, and weakness disappeared. The patient was also able to defecate and urinate normally. Cervical spondylotic myelopathy is a complex disease that may lead to significant clinical morbidity. The management requires an extensive knowledge of the anatomy, biomechanics, and surgical options. The variable clinical findings, radiological evidence and scoring system, such as JOA, are important for preoperative evaluation and individualising surgical planning. The choice of the most appropriate technique is affected by patient's clinical condition and radiologic findings as well as surgeon's experience. It is demonstrated that the Kurokawa-type laminoplasty that involves splitting the spinous processes in the midline offers the advantage of reduced bleeding as the lateral epidural venous plexus is not disturbed in comparison to that with the former Hirabayashi's expansive open-door laminoplasty. Moreover, the body symmetry is preserved; therefore, this procedure may be considered more anatomical and physiological. However, differences in the outcomes between the two approaches remain unknown. These findings suggest that the decompression and posterior stabilisation method may help achieve good patient outcomes. [ABSTRACT FROM AUTHOR]

Highlights • We used a newly developed, high-porosity unidirectional porous hydroxyapatite spacer with expectation of high bone conductive potential and biomechanical strength, both of which are essential for a lamina spacer for open-door type laminoplasty. • The aim of the present study was to elucidate the effectiveness of Regenos laminar spacers for open-door type laminoplasty. • Regenos spacers are not suitable for open-door laminoplasty because of adverse events. Abstract We used a newly developed, high-porosity unidirectional porous hydroxyapatite spacer (Regenos spacer, not approved by the FDA). The aim of the present study was to elucidate the effectiveness of Regenos laminar spacers for open-door type laminoplasty. The present study included 39 patients who underwent open-door type laminoplasty with Regenos spacers from April 2015 to December 2016 and were followed up for at least 6 months after surgery. We grafted 68 Regenos spacers in 39 patients. Pre- and postoperative neurological status of patients were evaluated using JOA score and recovery rate. Breakage of Regenos spacers, laminar closure, and bone-hydroxyapatite spacer bonding were assessed using 12-month postoperative sagittal and axial CT images. The average preoperative JOA score was 9.5 ± 3.2/17, and the average postoperative JOA score was 12.5 ± 2.9/17. JOA score recovery rate was 34 ± 41% at the latest follow-up visit. The bony fusion rate of the hinge sides was 87%. Breakage and deformity of implanted spacers was observed in 69% of patients and 59% of spacers with a CT sagittal view, and CT axial view at 12 months revealed fine cracks and collapse in 17 spacers in 14 patients. The average angle was −2.4 ± 4.8°, including 46 of 68 spacers showing a negative value, resulting in a rate of laminar reclosure of 35%. Postoperative CT demonstrated good bone bonding rate. Nevertheless, clinical results with low recovery rates were obtained with complications related to the use of Regenos spacers. [ABSTRACT FROM AUTHOR]

Objective To compare the clinical outcomes and postoperative complications between open-door laminoplasty (ODL) versus French-door laminoplasty (FDL) for the treatment of cervical multilevel compressive myelopathy. Methods We comprehensively searched PubMed, EMBASE, Cochrane library, and China National Knowledge Infrastructure to identify relevant articles. The search results were last updated on January 1, 2018. All values of weighted mean difference (WMD) and odds ratio are expressed as ODL relative to FDL. Results Six studies containing 430 patients were included in our meta-analysis. In randomized controlled trials, there was no significant difference in Japanese Orthopaedic Association (JOA) scores between ODL and FDL groups (WMD, 0.06; 95% confidence limits [CL], –0.52 to 0.64; P = 0.84). However, in the retrospective trials, JOA scores were significantly higher in the ODL group than in the FDL group (WMD, 0.95; 95% CL, 0.55–1.34; P < 0.05). The pooled data showed that the magnitude of spinal canal expansion in the ODL group was higher than in the FDL group (WMD, 24.39%; 95% confidence interval, 12.33–36.45; P < 0.05). Conclusions The present meta-analysis showed that the magnitude of canal expansion was higher with ODL than with FDL. There is a lack of compelling evidence to prove the superiority of one procedure over the other. [ABSTRACT FROM AUTHOR]

Study Design: A retrospective cohort study.Objective: The aim of this study was to identify the risk factors for acute progression of myelopathic symptoms (PMS) associated with ossification of the posterior longitudinal ligament (OPLL) after minor trauma and to compare the prognosis between an acute PMS group and a chronic PMS group.Summary Of Background Data: Although the prevalence of OPLL among patients with cervical myelopathy is high, few studies have been published regarding the risk factors for acute PMS associated with OPLL after minor trauma.Methods: Patients with OPLL who had histories of minor trauma and had undergone surgery were divided according to clinical course into an acute (within 48 hours, n = 38) and a chronic PMS group (n = 32). The type of trauma and the clinical and radiologic characteristics were compared. The clinical outcomes were also compared at admission and at 1 and 2 years postoperatively.Results: The types of trauma were significantly different between the two groups (P < 0.05). Univariate analysis revealed that older age, a narrower space available for the cord, and a higher rate of stenosis in the spinal canal were associated with acute PMS after minor trauma (P = 0.014, 0.020, and 0.006, respectively). However, the rate of stenosis in the spinal canal was the only risk factor that was identified in a multivariate analysis (P = 0.023; odds ratio, 0.872; 95% confidence interval, 0.774-0.982). The Japanese Orthopedic Association scores at the initial visit and at postoperative years 1 and 2 were significantly lower in the acute PMS group than in the chronic PMS group (P < 0.001, P < 0.001, and P < 0.001, respectively).Conclusion: One risk factor for acute PMS in patients with OPLL after minor trauma is a higher rate of stenosis of the spinal canal. Patients with acute PMS exhibited unfavorable neurologic outcomes. Preventive surgical treatment may be recommended for patients with significant OPLL with mild cervical myelopathy.Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective cohort study of prospectively collected data.Objective: To determine if laminoplasty (LP) is associated with worsening axial neck pain in patients with multilevel cervical myelopathy, and to compare neck pain, clinical outcomes, and radiographic measures in a group undergoing laminectomy and fusion (LF).Summary Of Background Data: Postoperative new or worsening axial neck pain is commonly cited as a major disadvantage of laminoplasty. However, there remains a paucity of corroborative data from large series.Methods: Following institutional review board approval, we reviewed the medical records, radiographs, and prospective clinical outcomes database of 85 patients undergoing LP and 52 patients undergoing LF for cervical myelopathy with minimum 1-year radiographic follow-up and average clinical follow-up of 18.5 months. LP was performed in those with neutral to lordotic C2-7 alignment and who did not complain of diffuse axial pain. Otherwise, LF was performed. Clinical outcomes included visual analogue score (VAS)-neck pain, VAS-total pain, neck disability index (NDI), short form 36, modified Japanese Orthopaedic Association (mJOA), and several radiographic parameters.Results: VAS-neck did not worsen in LP (-0.2, P = 0.54) and did improve in LF (-2.0, P = 0.0013). VAS-total improved significantly in both groups (LF -1.04 ± 0.52, P = 0.05; LP -1.4 ± 0.51, P = 0.008). NDI improved in both groups, but was significant in only LP (LP decreased 6.79 ± 2.25, P = 0.0032; LF decreased 4.01 ± 3.05, P = 0.19). mJOA scores improved significantly in both groups (LP improved 2.89 ± 0.27, P < 0.0001; LF improved 2.45 ± 0.33, P < 0.0001). There was a small loss of cervical lordosis in both groups that was significant in LP (LP 2.92° loss, P = 0.0181; LF 1.25° loss, P = 0.53).Conclusion: In a carefully selected group of myelopathic patients without significant diffuse axial pain preoperatively and appropriate sagittal alignment, laminoplasty did not lead to worsening axial neck pain, and it was associated with significant improvements in other clinical and myelopathy outcomes. Although laminoplasty is not indicated in every myelopathic patient, this study exemplifies its efficacy as a non-fusion operation in the appropriately selected patient and assuages concerns regarding worsening axial neck pain in such patients following surgery.Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]

Background Context: Open door laminoplasty (ODLP) can also lead to significant postoperative motion restriction that further increases over time, for which one of the possible factors is the bony impingement between neighboring posterior bony arches. Previously, we reported this phenomenon and modified technique of ODLP, wedge-shaped resection of the posterior bony arch that produced greater range of motion (ROM) of the cervical spine and less posterior neck pain compared with conventional ODLP (cODLP) in 1-year follow-up time, but no longer follow-up outcomes of the surgical technique has been reported.Purpose: The study aimed to thoroughly evaluate the impact of posterior bony impingement following ODLP on postoperative cervical motion and related outcomes, and to compare postoperative outcomes of conventional ODLP (cODLP with those of modified ODLP (mODLP) in 2-year follow-up times.Study Design: This is a retrospective comparative study.Patient Sample: A total of 145 patients who underwent cODLP or mODLP and were followed up for at least 2 years were classified into two groups: Group A (cODLP, 79 patients) and Group B (mODLP, 66 patients).Outcome Measures: The primary outcome measure was ROM of the cervical spine. Secondary outcome measures included (1) patient satisfaction, (2) radiological outcomes, including the rate of bony impingement and spontaneous fusion, and bone regrowth of the resection site, (3) clinical outcomes based on pain intensity and scores on the 12-item short-form health survey (SF-12) and neck disability index (NDI), (4) surgical outcomes, and (5) surgery-related complications.Methods: We compared baseline data in both groups. To evaluate the impact of our surgical modification on postoperative outcome after ODLP, we compared the outcome measures in 2-year follow-up times. No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.Results: The ROM of the cervical spine was significantly greater in Group B 2 years after surgery than in Group A (p=.001). Patient satisfaction (p=.02) at 2 years after surgery and pain intensity of the posterior neck at 1 (p=.01) and 2 years (p<.01) after surgery were better in Group B than in Group A. Radiological evidence of posterior bony impingement and spontaneous fusion between ODLPsegments were definitely fewer less in Group B than in Group A (p<.001 and<0.001, respectively). The mean value of bone regrowth was 1.2 mm (range, 0-3 mm). The NDI and SF-12 scores did not differ significantly between groups. Surgical outcomes and postoperative complications were similar between groups.Conclusions: These results indicate that posterior bony impingement can be a factor in ROM restriction after cODLP surgery and that wedge-shaped resection during ODLP can be a reliable option for preserving cervical ROM and improving postoperative clinical and radiological outcomes. [ABSTRACT FROM AUTHOR]

To investigate the clinical and radiographic fate of fractured hinges in open-door cervical laminoplasty, 135 segments of 36 patients who had undergone follow-up for more than two years after open-door cervical laminoplasty due to compressive cervical myelopathy were reviewed clinically and radiographically. Hinge fractures were identified by the intraoperative finding of obvious instability or click sounds (an obvious fracture), or by immediate postoperative computed tomography (CT) images showing a discontinuity of both the inner and outer cortex or a displacement of more than 1 mm at the lamina hinge site (an occult fracture). At two years post-surgery, union and displacement of the fractured hinges were evaluated with CT and the clinical outcome was assessed by the Japanese Orthopedic Association (JOA) and Neck Disability Index (NDI) scores. Immediate postoperative CT scans revealed 28 hinge fractures in 16 patients. Only three fractures were identified during surgery, with most being identified on postoperative CT. Nineteen laminae showed non-displaced cortical discontinuity, five were anteriorly displaced by more than 1 mm, and four were displaced posteriorly. Twenty-five laminae (89.3%) had achieved union according to the two-year postoperative CT scan. No de novo neurologic symptoms were found to be associated with hinge fracture. The two-year postoperative JOA and NDI scores did not differ significantly between patients with or without a hinge fracture. Most fractures at the hinge site occurred without intraoperative recognition, and usually re-unified without significant displacement or adverse clinical effects. When hinge fractures occur, careful observation without additional intervention is recommended. [ABSTRACT FROM AUTHOR]

Introduction: To evaluate the five year clinical and radiographic outcome of unilateral open-door laminoplasty with alternative levels centerpiece mini-plate fixation for cervical compressive myelopathy.Methods: From August 2009 to June 2010, 56 patients with cervical compressive myelopathy underwent unilateral open-door laminoplasty with alternative levels centerpiece mini-plate fixation with a mean age of 64.8 years. Clinical results were investigated including Japanese Orthopedic Association (JOA) scores, Neck Dysfunction Index (NDI), occurrences of complications and neurological deterioration. Radiographic results including cervical alignments, cervical range of motion (ROM), spinal canal enlargement and spinal cord decompression were assessed on X-ray, three-dimensional CT and MRI.Results: The mean follow-up period was 59.2 months (range 53∼64 months), and all patients achieved osseous fusion at hinge side at an average of 6.8 months after operation. The average cost from admission to discharge is $9817.9. Compared to previous all-level fixation, the cost decreased nearly 40 %. During the follow-up, all patients showed a significant improvement in the JOA score and NDI score. A 23.2 % incidence of axial neck pain were also observed; Significant enlargement of the spinal canal and spinal cord drift was achieved and well maintained, overall cervical ROM decreased by 27.1 % (mean 12.9° loss) at the final follow-up and cervical lordosis decreased slightly in all patients without statistic difference. No instrumentation failure or lamina reclosure was observed in our study. Comparing mini-plate segments and suture segments, the mean AP diameter and Pavlov's ratio at the final follow-up showed no statistic difference, only open angle at the final follow-up showed significant decrease.Conclusions: Unilateral open-door laminoplasty with alternative levels centerpiece mini-plate fixation is a safe, effective and economical surgical method for cervical compressive myelopathy and the five year result is satisfactory. [ABSTRACT FROM AUTHOR]

Purpose: The presence of preoperative kyphosis has been identified as a risk factor for laminar closure (LC). We have been performing modified open-door laminoplasty with reattachment of the spinous processes and extensor musculature for patients with reduced cervical lordosis because this procedure can prevent progression of cervical kyphosis. This procedure may also prevent LC. The purpose of this study was to evaluate the rate of LC after the modified open-door laminoplasty.Methods: A total of 104 patients who underwent open-door laminoplasty were retrospectively reviewed. Of these patients, 18 underwent modified open-door laminoplasty (group M), whereas the other 86 underwent Hirabayashi open-door laminoplasty (group H). Group H was divided into two classes according to the preoperative cervical lordosis angle (group H1 ≤ 10° vs. group H2 ≥ 11°). All 18 patients in group M had a preoperative lordosis angle ≤10°. The outcomes were assessed using the rate of LC, the cross-sectional area (CSA) of the erector muscle on magnetic resonance imaging, and the Japanese Orthopaedic Association score (JOA score).Results: The rate of laminar closure was significantly lower in group M (39 %) than in group H1 (76 %) (P < 0.01). The CSAs tended to be larger in the muscle preservation side of group M than in the other groups. There was no significant difference in the JOA score among the three groups.Conclusions: Although patients with decreased cervical lordosis have a higher risk of LC, the results suggested that modified open-door laminoplasty could reduce the rate of LC compared with Hirabayashi open-door laminoplasty. [ABSTRACT FROM AUTHOR]

Purpose: To introduce a new simple technique using suture anchors and ceramic spacers to stabilize the elevated laminae in open-door cervical laminoplasty. Although ceramic spacers were placed in the opened laminae and fixed with nylon threads in this series, it was occasionally difficult to fix the nylon threads to the lateral mass. Materials and Methods: Study 1: A preliminary study was conducted using a suture anchor system. Sixteen consecutive patients who underwent surgery for cervical myelopathy were prospectively examined. Study 2: The second study was performed prospectively to evaluate the feasibility of this new technique based on the result of the preliminary study. Clinical outcomes were examined in 45 consecutive patients [cervical spondylotic myelopathy (CSM)] and 43 consecutive patients (OPLL). The Japanese Orthopedic Association scoring system (JOA score), axial neck pain, and radiological findings were analyzed. Results: 1) In one case, re-operation was necessary due to dislodgement of the ceramic spacer following rupture of the thread. 2) In all patients, postoperative CT scans showed that the anchors were securely inserted into the bone. In the CSM group, the average JOA score improved from 9.5 points preoperatively to 13.3 at follow-up (recovery 51%). In the OPLL group, the average JOA score improved from 10.1 (5-14) points preoperatively to 14.4 (11-16) at follow-up (recovery 62%). There were no serious complications. Conclusion: The use of the suture anchor system made it unnecessary to create a hole in the lateral mass and enabled reliable and faster fixation of the HA spacers in open-door laminoplasty. [ABSTRACT FROM AUTHOR]

Objective: To investigate and evaluate the biomechanical behaviour of tension-band-reconstruction (TBR) and ordinary titanium plates in open-door laminoplasty by finite element (FE) analysis.Methods: TBR titanium plate and ordinary titanium plate were implanted into a validated finite element model of healthy adult cervical vertebrae. Among them, 5 ordinary titanium plate were used in model A, 2 TBR titanium plates and 3 ordinary titanium plates were used in model B, and 5 TBR titanium plates were used in model C. The same loading conditions was applied identically to all models. Range of motion (ROM) of the vertebral body, stress distribution of the titanium plate and intradiscal pressure (IDP) were compared in flexion, extension, lateral bending and rotation.Results: The ROM of model B and C was similar in flexion and extension, and both were smaller than that of model A. The highest von Mises stress in the titanium plate appears is in model C. The IDP in C2/3 was significantly higher than that in other segments in flexion. There was no significant difference in IDP among three models in left lateral bending and left axial rotation.Conclusion: Application of TBR titanium plate in open-door laminoplasty can reduced ROM in flexion, extension and axial rotation of the cervical vertebrae. But the increase of stress in TBR titanium plate could lead to higher risk of adverse events such as titanium plate deformation. Moreover, compared with complete TBR titanium plate, the combination of TBR titanium plate for C3 and C7 with ordinary titanium plate for the other vertebrae largely reduce the stress of the titanium plates by ensuring stability. The proposed FE model (C2-T1) exhibits a great potential in evaluating biomechanical behaviour of TBR titanium plate for open-door laminoplasty. [ABSTRACT FROM AUTHOR]