Abstract

ObjectivePosterior open-door laminoplasty (PODL) is a common procedure for treating multilevel cervical spondylotic myelopathy (MCSM). Little information is available regarding the cervical sagittal balance and surgical efficacy of PODL when securing with different methods. Therefore, this study aims to investigate the clinical outcomes and the changes in cervical sagittal parameters and balance associated with PODL secured with titanium miniplates vs anchors.MethodA retrospective analysis was performed on the clinical data of 79 patients with MCSM who were treated in our institution from January 2015 to December 2016. Among them, 42 patients were treated by PODL secured with titanium miniplates (group A) and 37 patients by PODL secured with anchors (group B). Surgical time, intraoperative blood loss, hospital stay, hospitalized cost, VAS scores of neck pain, JOA scores, neck disability index (NDI), and improvement rate of spinal neurological function (IRNF) were recorded before surgery and at 12 months after surgery. Before surgery, at 1 month and 2 years after surgery, the following radiological parameters were recorded and compared on the lateral cervical X-ray images: the distance from the vertical axis of C2 sagittal plane to the posterior superior edge of C7 (C2-7 SVA), the inclusion angle of tangent between C2 and C7 trailing edge (C2-7 Cobb angle), and the intersection angle between the upper edge of T1 and the horizontal line (T1 Slope).ResultComparing the two groups, there were no significant differences in surgical time, intraoperative blood loss, hospital stay, VAS, JOA, and NDI scores before surgery (P > 0.05); however, the hospitalized cost of group A were much higher than those of the group B (P < 0.05). At 2 years after surgery in the two groups, there was a significant reduction in VAS and NDI scores (P < 0.05), and JOA scores increased significantly (P < 0.05). In addition, there were no significant differences in VAS, JOA and IRNF between the two groups (P > 0.05); however, NDI scores of group A were better than those of group B (P < 0.05). In radiological parameters, before surgery, the two groups showed no significant differences in C2-7 SVA, C2-7 Cobb angle, and T1 slope (P > 0.05); however, after surgery, C2-7 SVA and T1 slope increased (P < 0.05), while C2-7 Cobb angle decreased (P < 0.05). At 2 years after surgery, the two groups did not differ significantly in C2-7 Cobb angle and T1 slope (P > 0.05), while C2-7 SVA of group A was superior to that of group B (P < 0.05). The difference value of C2-7 SVA measured before and after surgery was correlated negatively with that of NDI scores (P < 0.05).ConclusionPODL secured with titanium miniplates or anchors achieved good clinical efficacy in the treatment of MCSM. However, the patients with miniplates feel a better cervical functional status, while those with anchors spend less on hospitalization. Both methods lead to anteversion of cervical spine, but cervical sagittal balance after miniplates is better than that of anchors.

Highlights

  • Cervical degenerative disease is a major cause of spinal diseases, and its incidence has been rising in the elderly people [1,2,3]

  • Posterior open-door laminoplasty (PODL) secured with titanium miniplates or anchors achieved good clinical efficacy in the treatment of multi-segmental cervical spondylotic myelopathy (MCSM)

  • Clinical efficacy and radiologic parameters were compared between PODL secured with titanium miniplates and anchors

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Summary

Introduction

Cervical degenerative disease is a major cause of spinal diseases, and its incidence has been rising in the elderly people [1,2,3]. Posterior open-door laminoplasty (PODL) is the primary treatment for multi-segmental cervical spondylotic myelopathy (MCSM), developmental cervical spinal canal stenosis, ossification of cervical posterior longitudinal ligament, and so on. Studies have shown this surgical approach has definite and enduring efficacy in releasing spinal compression and improving the function of nervous system [1,2,3,4,5,6,7]. Silk suspension is to tie the silk into the space between the spinous process and articular capsule of the doorshaft side This method has lower biomechanical strength, and re-closure of the opened lamina may occur, resulting in relapse of the neurological symptoms [1, 8]. More studies are devoted to coronal-sagittal balance of the lumbar spine and the influence of spinal-pelvic parameters on postoperative lumbar spine [14, 15], while few are focused on the postoperative cervical sagittal parameters and changes in cervical sagittal balance

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