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Union Rate on Hinge Side after Open-Door Laminoplasty Using Maxillofacial Titanium Miniplate

DOI: 10.1155/2013/767343

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Abstract:

Background. One of the important complications of open-door laminoplasty is a premature laminoplasty closure. In order to prevent premature laminoplasty closure many techniques have been described and a titanium miniplate is one of the instruments to maintain cervical canal expansion. This study was performed to evaluate the effectiveness of titanium miniplates on the union rate for open-door laminoplasty. Materials and Methods. We performed open-door laminoplasty in 68 levels of fourteen patients using maxillofacial titanium miniplates. Axial computed tomography scans were obtained at 6 months postoperatively to evaluate the union rates of the hinge side. The Japanese Orthopedic Association (JOA) score was used to compare the clinical outcomes before and after surgery. Results. Computed tomography scan data was available on 68 levels in 14 patients. There were no premature closures of the hinge or miniplate dislodgements. The union rate on the hinge side was 70.5% (48/68). The mean JOA score increased significantly from 7.0 before surgery to 10.2, 12.2, and 13.0 after surgery at 1, 3, and 6 months, respectively. Conclusion. Open-door laminoplasty using maxillofacial titanium miniplates can provide union rates comparable to other techniques. It can maintain canal expansion without failures, dislodgements, and premature closures. 1. Introduction Open-door laminoplasty is a standard procedure for the treatment of multiple levels of cervical spondylotic myelopathy and ossification of posterior longitudinal ligaments (OPLL). There are several techniques to maintain cervical canal expansion such as the Hirabayashi technique [1] which is the classic open-door laminoplasty that maintains cervical canal expansion by suturing to the contralateral soft tissue. The Itoh and Tsuji technique [2] maintains an elevated lamina by a spinous process spacer with suturing to the lateral mass. However, sutures do not provide a rigid fixation [3] and so premature laminoplasty closure is one of the important complications in open-door laminoplasty which results in subsequent restenosis. In one series using suturing techniques, patients developed some degree of reclosure at one or more levels up to 34% [4]. In order to prevent premature laminoplasty closure with a rigid fixation many techniques such as ceramic spacers, bone strut grafts, and plating systems have been introduced. However, bone struts and ceramic spacers are associated with the potential of graft dislodgement which can lead to reclosure of laminoplasty or neurological deficit if the spacers dislodge into the

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