Zheng Bin, Zhu Zhenqi, Liang Yan, Liu Haiying
Spine Surgery, Peking University People's Hospital, Beijing, China.
Orthop Surg. 2025 Jul;17(7):2141-2149. doi: 10.1111/os.70100. Epub 2025 Jun 8.
Titanium mini-plates are applied in unilateral open-door laminoplasty to secure the elevated laminae and prevent re-closure. Whereas the conventional technique fixates every level, some surgeons plate only alternate levels to curb implant costs. Whether they could achieve similar long-term clinical and radiographic efficacy is still questionable. This study aimed to compare the efficacy and safety of alternative-level fixation versus all-level fixation in cervical laminoplasty for multilevel cervical spondylotic myelopathy (CSM).
A retrospective analysis is conducted on 65 patients who underwent C3-C7 unilateral laminoplasty at Peking University People's Hospital from July 2012 to December 2020. Patients are divided into two groups: alternative-level fixation and all-level fixation. Clinical outcomes, including operative time, intraoperative blood loss, postoperative hospitalization days, and complications, are assessed. The Japanese Orthopaedic Association (JOA) score is used for neurological function evaluation, while pain is assessed with the Visual Analog Scale (VAS). Radiographic outcomes include changes in anterior-posterior diameter, Pavlov ratio, cervical lordosis (CL), thoracic slope (T1S), and sagittal vertical axis (SVA).
Both groups showed significant improvements in JOA (15.94 ± 0.85 vs. 8.74 ± 1.76 in alternative-level and 16.1 ± 0.79 vs. 8.42 ± 1.84 in all-level) and VAS (1.03 ± 0.87 vs. 5.79 ± 1.18 in alternative-level, 1.06 ± 0.77 vs. 5.35 ± 1.17 in all-level) postoperatively, with no statistically significant differences in clinical outcomes between the groups (JOA: 15.94 ± 0.85 vs. 16.1 ± 0.79, p = 0.394; VAS: 1.03 ± 0.87 vs. 1.06 ± 0.77, p = 0.432). Although total hospital costs are significantly lower in the alternative-level fixation group (124,937 ± 5104.01 RMB vs. 88007.53 ± 7014.53, p < 0.001), the all-level fixation group demonstrated better long-term preservation of APD (17.87 ± 0.60 vs. 17.50 ± 0.52) at the final follow-up. Radiographic outcomes, including CL, T1s, and cSVA, show no significant differences between the two groups, indicating comparable spinal alignment outcomes.
Both all-level and alternative-level fixation methods effectively support the lamina and prevent reclosure, with significant improvement in clinical symptoms in both groups at the final follow-up, showing no significant difference in postoperative clinical outcomes between the two. There are no differences in sagittal parameters. All-level fixation method showed better preservation of the spinal canal diameter.
钛微型钢板用于单开门椎管扩大成形术中固定抬起的椎板并防止其再次闭合。传统技术会固定每个节段，而一些外科医生仅固定交替节段以控制植入物成本。它们是否能实现相似的长期临床和影像学疗效仍存在疑问。本研究旨在比较交替节段固定与全节段固定在多节段脊髓型颈椎病（CSM）颈椎管扩大成形术中的疗效和安全性。
对2012年7月至2020年12月在北京大学人民医院接受C3 - C7单开门椎管扩大成形术的65例患者进行回顾性分析。患者分为两组：交替节段固定组和全节段固定组。评估临床结果，包括手术时间、术中出血量、术后住院天数和并发症。采用日本骨科学会（JOA）评分评估神经功能，采用视觉模拟量表（VAS）评估疼痛。影像学结果包括前后径、Pavlov比值、颈椎前凸（CL）、胸椎后凸角（T1S）和矢状垂直轴（SVA）的变化。
两组术后JOA评分（交替节段固定组：15.94 ± 0.85 vs. 术前8.74 ± 1.76；全节段固定组：16.1 ± 0.79 vs. 术前8.42 ± 1.84）和VAS评分（交替节段固定组：1.03 ± 0.87 vs. 术前5.79 ± 1.18；全节段固定组：1.06 ± 0.77 vs. 术前5.35 ± 1.17）均有显著改善，两组临床结果无统计学差异（JOA评分：15.94 ± 0.85 vs. 16.1 ± 0.79，p = 0.394；VAS评分：1.03 ± 0.87 vs. 1.06 ± 0.77，p = 0.432）。尽管交替节段固定组的总住院费用显著更低（124,937 ± 5104.01元 vs. 88007.53 ± 7014.53元，p < 0.001），但全节段固定组在末次随访时显示出更好的椎管前后径长期保留情况（17.87 ± 0.60 vs. 17.50 ± 0.52）。包括CL、T1S和cSVA在内的影像学结果在两组间无显著差异，表明脊柱对线结果相当。
全节段和交替节段固定方法均能有效支撑椎板并防止再次闭合，两组在末次随访时临床症状均有显著改善，术后临床结果无显著差异。矢状面参数无差异。全节段固定方法在椎管直径保留方面表现更好。
