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

• Lee DY
• Lee CK
• Kim IS

• KMID: 2417343
• DOI: http://doi.org/10.3340/jkns.2016.59.6.604

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

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  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.

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  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.

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

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

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

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

Reference

1. Chiba K, Ogawa Y, Ishii K, Takaishi H, Nakamura M, Maruiwa H, et al. Long-term results of expansive open-door laminoplasty for cervical myelopathy--average 14-year follow-up study. Spine (Phila Pa 1976). 2006; 31:2998–3005. PMID: 17172996.

2. Hirabayashi K, Watanabe K, Wakano K, Suzuki N, Satomi K, Ishii Y. Expansive open-door laminoplasty for cervical spinal stenotic myelopathy. Spine (Phila Pa 1976). 1983; 8:693–699. PMID: 6420895.

3. Iwasaki M, Kawaguchi Y, Kimura T, Yonenobu K. Long-term results of expansive laminoplasty for ossification of the posterior longitudinal ligament of the cervical spine : more than 10 years follow up. J Neurosurg. 2002; 96(2 Suppl):180–189. PMID: 12450281.

4. Jin SW, Kim SH, Kim BJ, Choi JI, Ha SK, Kim SD, et al. Modified open-door laminoplasty using hydroxyapatite spacers and miniplates. Korean J Spine. 2014; 11:188–194. PMID: 25346767.

5. Kanemura A, Doita M, Iguchi T, Kasahara K, Kurosaka M, Sumi M. Delayed dural laceration by hydroxyapatite spacer causing tetraparesis following double-door laminoplasty. J Neurosurg Spine. 2008; 8:121–128. PMID: 18248283.

6. Kawaguchi Y, Kanamori M, Ishihara H, Ohmori K, Nakamura H, Kimura T. Minimum 10-year followup after en bloc cervical laminoplasty. Clin Orthop Relat Res. 2003; (411):129–139.

7. Kimura A, Seichi A, Inoue H, Hoshino Y. Long-term results of double-door laminoplasty using hydroxyapatite spacers in patients with compressive cervical myelopathy. Eur Spine J. 2011; 20:1560–1566. PMID: 21336508.

8. Kimura I, Shingu H, Nasu Y. Long-term follow-up of cervical spondylotic myelopathy treated by canal-expansive laminoplasty. J Bone Joint Surg Br. 1995; 77:956–961. PMID: 7593114.

9. Kong Q, Zhang L, Liu L, Li T, Gong Q, Zeng J, et al. Effect of the decompressive extent on the magnitude of the spinal cord shift after expansive open-door laminoplasty. Spine (Phila Pa 1976). 2011; 36:1030–1036. PMID: 21150700.

10. Kubo S, Goel VK, Yang SJ, Tajima N. Biomechanical evaluation of cervical double-door laminoplasty using hydroxyapatite spacer. Spine (Phila Pa 1976). 2003; 28:227–234. PMID: 12567022.

11. Martin-Benlloch JA, Maruenda-Paulino JI, Barra-Pla A, Laguia-Garzaran M. Expansive laminoplasty as a method for managing cervical multilevel spondylotic myelopathy. Spine (Phila Pa 1976). 2003; 28:680–684. PMID: 12671355.

12. Nakano K, Harata S, Suetsuna F, Araki T, Itoh J. Spinous process-splitting laminoplasty using hydroxyapatite spinous process spacer. Spine (Phila Pa 1976). 1992; 17(3 Suppl):S41–S43. PMID: 1314432.

13. Nakashima H, Kato F, Yukawa Y, Imagama S, Ito K, Machino M, et al. Comparative effectiveness of open-door laminoplasty versus French-door laminoplasty in cervical compressive myelopathy. Spine (Phila Pa 1976). 2014; 39:642–647. PMID: 24503689.

14. Ogawa Y, Chiba K, Matsumoto M, Nakamura M, Takaishi H, Hirabayashi H, et al. Long-term results after expansive open-door laminoplasty for the segmental-type of ossification of the posterior longitudinal ligament of the cervical spine : a comparison with nonsegmental-type lesions. J Neurosurg Spine. 2005; 3:198–204. PMID: 16235702.

15. Okada M, Minamide A, Endo T, Yoshida M, Kawakami M, Ando M, et al. A prospective randomized study of clinical outcomes in patients with cervical compressive myelopathy treated with open-door or French-door laminoplasty. Spine (Phila Pa 1976). 2009; 34:1119–1126. PMID: 19444058.

16. Park JH, Jeon SR. Midline-splitting open door laminoplasty using hydroxyapatite spacers : comparison between two different shaped spacers. J Korean Neurosurg Soc. 2012; 52:27–31. PMID: 22993674.

17. Patel CK, Cunningham BJ, Herkowitz HN. Techniques in cervical laminoplasty. Spine J. 2002; 2:450–455. PMID: 14589270.

18. Ratliff JK, Cooper PR. Cervical laminoplasty : a critical review. J Neurosurg. 2003; 98(3 Suppl):230–238. PMID: 12691377.

19. Sakaura H, Hosono N, Mukai Y, Ishii T, Iwasaki M, Yoshikawa H. Long-term outcome of laminoplasty for cervical myelopathy due to disc herniation : a comparative study of laminoplasty and anterior spinal fusion. Spine (Phila Pa 1976). 2005; 30:756–759. PMID: 15803077.

20. Shimamura T, Kato S, Toba T, Yamazaki K, Ehara S. Sagittal splitting laminoplasty for spinal canal enlargement for ossification of the spinal ligaments (OPLL and OLF). Semin Musculoskelet Radiol. 2001; 5:203–206. PMID: 11500167.

21. Suk KS, Kim KT, Lee JH, Lee SH, Lim YJ, Kim JS. Sagittal alignment of the cervical spine after the laminoplasty. Spine (Phila Pa 1976). 2007; 32:E656–E660. PMID: 17978640.

22. Tanaka N, Nakanishi K, Fujimoto Y, Sasaki H, Kamei N, Hamasaki T, et al. Expansive laminoplasty for cervical myelopathy with interconnected porous calcium hydroxyapatite ceramic spacers : comparison with autogenous bone spacers. J Spinal Disord Tech. 2008; 21:547–552. PMID: 19057246.

23. Tsuji H. Laminoplasty for patients with compressive myelopathy due to so-called spinal canal stenosis in cervical and thoracic regions. Spine (Phila Pa 1976). 1982; 7:28–34. PMID: 7071659.

24. Yang SC, Niu CC, Chen WJ, Wu CH, Yu SW. Open-door laminoplasty for multilevel cervical spondylotic myelopathy : good outcome in 12 patients using suture anchor fixation. Acta Orthop. 2008; 79:62–66. PMID: 18283574.