J Korean Neurosurg Soc.  2016 Nov;59(6):604-609. 10.3340/jkns.2016.59.6.604.

A Comparison of Implants Used in Double Door Laminoplasty : Allogeneic Bone Spacer versus Hydroxyapatite Spacer

Affiliations
  • 1Department of Neurosurgery, Keimyung University, School of Medicine, Dongsan Medical Center, Daegu, Korea. neurokim@dsmc.or.kr

Abstract


OBJECTIVE
The aim of this study was to compare the clinical and radiological outcomes associated with the use of hydroxyapatite (HA) spacer and allogeneic bone (AB) spacer in laminoplasty.
METHODS
From January 2006 to July 2014, 79 patients with cervical spondylotic myelopathy or ossification of the posterior longitudinal ligament underwent cervical laminoplasty. The radiologic parameters were obtained from plain radiography and three-dimensional computed tomography. All images were taken before and after surgery. Cervical lordosis, spinal canal dimension, fusion between lamina and spacer, and resorption of spacer were checked. Clinical outcomes were assessed using visual analog scale and Japanese Orthopedic Association.
RESULTS
Double-door laminoplasty was performed on 280 levels : 182 in the HA group and 98 in the AB group. The mean follow-up was 23.1 months (range : 4-69 months). Similar fusion rates were found in these groups (p=0.3). The resorption rate between lamina and spacer was lower in the HA group (p<0.001). During the immediate postoperative period, the canal dimension of both groups increased compared with the results in the preoperative period. However, the canal dimension of the AB group decreased over time compared with that of the HA group (p<0.001).
CONCLUSION
Double-door laminoplasty improved the clinical outcomes of both groups. However, the spinal canal dimension in the AB group showed a greater degree of reduction than in the HA group at the final postoperative follow-up. Therefore, we suggest that surgeons consider the use of larger-sized AB spacers in double-door laminoplasties.

Keyword

Allograft; Hydroxyapatites; Cervical myelopathy; Ossification of posterior longitudinal ligament; Spinal fusion

MeSH Terms

Allografts
Animals
Asian Continental Ancestry Group
Durapatite*
Follow-Up Studies
Humans
Hydroxyapatites
Laminoplasty*
Longitudinal Ligaments
Lordosis
Orthopedics
Ossification of Posterior Longitudinal Ligament
Postoperative Period
Preoperative Period
Radiography
Spinal Canal
Spinal Cord Diseases
Spinal Fusion
Surgeons
Visual Analog Scale
Durapatite
Hydroxyapatites

Figure

  • Fig. 1 Cervical lordosis, defined as the angle between C2 and C7 inferior end plates. A : Pre-op. B : Immediately post op. C : Final follow up.

  • Fig. 2 Spacer resorption was defined that the shape of spacer is smaller or changed on CT images. A : Immediately post op. B : Final follow up.

  • Fig. 3 The spinal canal dimension change in HA group. A : Immediately post op. B : Final follow up. HA : hydroxyapatite.

  • Fig. 4 The spinal canal dimension change in AB group. A : Immediately post op. B : Final follow up. AB : allogeneic bone.

  • Fig. 5 Clinical outcome in JOA scores compared between preoperative, immediately post operative and final follow up.

  • Fig. 6 Clinical outcome in VAS scores compared between preoperative, immediately post operative and final follow up.


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