Yonsei Med J.  2015 Nov;56(6):1651-1655. 10.3349/ymj.2015.56.6.1651.

Modified Open-Door Laminoplasty Using a Ceramic Spacer and Suture Fixation for Cervical Myelopathy

• Ozawa T
• Toyone T
• Shiboi R
• Inada K
• Oikawa Y
• Takahashi
• Ohtori S
• Inoue G
• Miyagi M
• Ishikawa T
• Shirahata
• Kudo Y
• Inagaki K

• KMID: 2345896
• DOI: http://doi.org/10.3349/ymj.2015.56.6.1651

Abstract

PURPOSE
To introduce a new simple technique using suture anchors and ceramic spacers to stabilize the elevated laminae in open-door cervical laminoplasty. Although ceramic spacers were placed in the opened laminae and fixed with nylon threads in this series, it was occasionally difficult to fix the nylon threads to the lateral mass.
MATERIALS AND METHODS
Study 1: A preliminary study was conducted using a suture anchor system. Sixteen consecutive patients who underwent surgery for cervical myelopathy were prospectively examined. Study 2: The second study was performed prospectively to evaluate the feasibility of this new technique based on the result of the preliminary study. Clinical outcomes were examined in 45 consecutive patients [cervical spondylotic myelopathy (CSM)] and 43 consecutive patients (OPLL). The Japanese Orthopedic Association scoring system (JOA score), axial neck pain, and radiological findings were analyzed.
RESULTS
1) In one case, re-operation was necessary due to dislodgement of the ceramic spacer following rupture of the thread. 2) In all patients, postoperative CT scans showed that the anchors were securely inserted into the bone. In the CSM group, the average JOA score improved from 9.5 points preoperatively to 13.3 at follow-up (recovery 51%). In the OPLL group, the average JOA score improved from 10.1 (5-14) points preoperatively to 14.4 (11-16) at follow-up (recovery 62%). There were no serious complications.
CONCLUSION
The use of the suture anchor system made it unnecessary to create a hole in the lateral mass and enabled reliable and faster fixation of the HA spacers in open-door laminoplasty.

Keyword

Open-door laminoplasty; ceramic spacer; suture anchor fixation

MeSH Terms

Adult
Aged
*Ceramics
Cervical Vertebrae/radiography
Feasibility Studies
Female
Follow-Up Studies
Humans
Laminoplasty/*methods
Male
Middle Aged
Postoperative Period
Prospective Studies
Spinal Cord Diseases/*surgery
Suture Anchors
*Sutures
Tomography, X-Ray Computed
Treatment Outcome

Figure

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  Fig. 1 The Mitek Mini Quick Anchor Plus system. Length 5.4 mm.

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  Fig. 2 Pedicle level insertion in eight patients used anchors inserted within the bone, while foramen level insertion in two of the eight patients used anchors that were displaced outside of the bone.

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  Fig. 3 Displacement in the intervertebral foramen can be observed with an insertion angle of 30° or less.

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  Fig. 4 Displacement in an intervertebral foramen (69-year-old woman with cervical spondylotic myelopathy). (A) Pedicle level. (B) Upper foramen level. (C) Foramen level.

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  Fig. 5 Placement of a spacer in the lower cervical vertebra was facile when using an anchor that did not interfere with the rod. (A) Postoperative X-ray image. (B) CT of C4 level. (C) CT of C6 level.

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