Single-Door Cervical Laminoplasty Using Titanium Miniplates Alone

• Published in: Journal of orthopaedic surgery (Hong Kong) Vol. 23; no. 2; pp. 174 - 179
• Main Authors: Tung, Kam Lung, Cheung, Philip, Kwok, Tik Koon, Wong, Kam Kwong, Mak, Kan Hing, Wong, Wing Cheung
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01-08-2015; Sage Publications Ltd; SAGE Publishing
• Subjects: Adult; Aged; Bone Plates; Bone Screws; Bone Transplantation - methods; Cervical Vertebrae - surgery; Equipment Design; Female; Humans; Hydroxyapatite; Intubation; Laminoplasty - methods; Male; Middle Aged; Miniaturization; Neck; Patients; Retrospective Studies; Spinal cord; Spinal Cord Diseases - surgery; Sports injuries; Titanium; spinal cord diseases; laminoplasty
• ISSN: 1022-5536; 2309-4990
• DOI: 10.1177/230949901502300211

Purpose.
To review outcome of 29 patients who underwent single-door cervical laminoplasty for myelopathy using titanium miniplates alone.
Methods.
Records of 20 men and 9 women aged 35 to 79 (mean, 64.3) years who underwent single-door cervical laminoplasty for myelopathy using titanium miniplates alone were reviewed. A total of 125 laminae were opened; 97 of them were fixed with a titanium miniplate. In 19 patients, a 20-hole titanium miniplate bent to the contour of a lamina was used and fixed into 3 laminae at alternate levels. In the remaining 10 patients, the pre-contoured ARCH Laminoplasty System was used and fixed into all laminae. In most patients, screw fixation was unicortical, and no spacer or bone graft was used.
Results.
The mean follow-up duration was 4 (range, 2–9) years. At one-year follow-up, the mean Japanese Orthopaedic Association (JOA) score improved from 9.2 to 13.2 (p<0.001). The mean JOA recovery rate was 64%. No patient had neurological deterioration. The mean anteroposterior diameter increased from 14.3 mm to 19.7 mm; the mean increase was 6.1 mm in the plated laminae and 5.3 mm in the unplated laminae (p=0.11). Out of the 125 laminae, there were 2 hinge non-unions in the unplated laminae, and 2 screw pullouts (not associated with plate loosening). No patient had penetration into the vertebral foramen or neuroforamen. Spring-back closure occurred in 5 (18%) of the 28 unplated laminae, with a mean of <3 mm loss of the initial expansion. Two patients developed transient C5 palsy presenting as shoulder abduction weakness. One patient had a delayed dural tear due to a sharp spike at the edge of the opened C6 lamina.
Conclusion.
Single-door cervical laminoplasty using miniplates alone is a safe technique and achieves a high hinge union rate, good canal expansion, and neurological recovery.