Comparable clinical and radiological outcomes between skipped-level and all-level plating for open-door laminoplasty

Abstract

Purpose: To compare the clinical and radiological outcomes between skipped-level and all-level plating for cervical laminoplasty. Methods: Patients with cervical spondylotic myelopathy (CSM) treated by open-door laminoplasty with minimum 2-year postoperative follow-up were included. All patients had opening from C3–6 or C3–7 and were divided into skipped-level or all-level plating groups. Japanese Orthopaedic Association (JOA) scores and canal measurements were obtained preoperatively, immediate (within 1 week) postoperatively, and at 2, 6 weeks, 3, 6 and 12 months postoperatively. Paired t test was used for comparative analysis. Receiver operating characteristic analysis was used to determine the canal expansion cutoff for spring-back closure. Results: A total of 74 subjects were included with mean age of 66.1 ± 11.3 years at surgery. Of these, 32 underwent skipped-level plating and 42 underwent all-level plating. No significant differences were noted between the two groups at baseline and follow-up. Spring-back closure was observed in up to 50% of the non-plated levels within 3 months postoperatively. The cutoff for developing spring-back closure was 7 mm canal expansion for C3–6. No differences were observed in JOA scores and recovery rates between the two groups. None of the patients with spring-back required reoperation. Conclusions: There were no significant differences between skipped-level and all-level plating in terms of JOA or recovery rate, and canal diameter differences. This has tremendous impact on saving costs in CSM management as up to two plates per patient undergoing a standard C3–6 laminoplasty may be omitted instead of four plates to every level to achieve similar clinical and radiological outcomes. Level of evidence: III. Graphical abstract: These slides can be retrieved under Electronic Supplementary Material.