Titanium mini-plates prevent springback closure in single-door cervical laminoplasty

Abstract

INTRODUCTION: Springback closure after single-door cervical laminoplasty is a known and feared complication. It's incidence and consequence has been poorly defined, and various techniques have been used to prevent its occurrence. With technological advancement, we progressed from sutures, to Mitek anchors, to titanium mini-plates. The latter represented a viable alternative with other potential benefits. METHODS: Two cohorts of patients who underwent single-door cervical laminoplasty for spondylotic myelopathy and ossification of posterior longitudinal ligament were compared. One cohort, 30 patients, had laminoplasty hinges stabilized using traditional Hirabayashi suturing technique. The other cohort, 12 patients, had titanium mini-plates, with various patterns of plating ranging from plating at all levels to plating at 2 levels. Springback was defined as ≧ 4mm in -posterior diameter, and loss of end-on lamina silhouette and re-appearance of lateral profile of spinous process on lateral x-ray. Modified JOA score and recovery rates were the secondary outcome measures for this study. RESULTS: There were 3 patients in Hirabayashi group with springback closure. All were partial and segmental. For the latter group, there was no springback closure by our definition, though at levels without mini-plate a mild decrease in APD was noted in a few instances. Those with springback required revision surgery, but only had partial recovery. CONCLUSION: Springback closure represents a complication that can result in neurological deterioration and maybe revision surgery. Titanium mini-plates represents an excellent alternative to Hirabayashi technique with added benefit of potentially reducing axial neck pain & neck collar use due to its immediate stability.