Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Risk Factors for Delayed Hinge Fracture after Plate-Augmented Cervical Open-Door Laminoplasty

  • Hur, Junseok W. (Department of Neurosurgery, Korea University Guro Hospital) ;
  • Park, Youn-Kwan (Department of Neurosurgery, Korea University Guro Hospital) ;
  • Kim, Bum-Joon (Department of Neurosurgery, Korea University Guro Hospital) ;
  • Moon, Hong-Joo (Department of Neurosurgery, Korea University Guro Hospital) ;
  • Kim, Joo-Han (Department of Neurosurgery, Korea University Guro Hospital)
  • Received : 2015.01.05
  • Accepted : 2016.03.20
  • Published : 2016.07.01
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : Delayed hinge fracture (HF) that develops after cervical open door laminoplasty can be a source of postoperative complications such as axial pain. However, risk factors related to this complication remain unclear. We performed a retrospective clinical series to determine risk factors for delayed HF following plate-only open-door cervical laminoplasty. Methods : Patients who underwent plate-only open-door laminoplasty and had available postoperative computed tomography (CT) scans (80 patients with 270 laminae) were enrolled. Hinge status, hinge gutter location, open location, hinge width, number of screws used, operation level, and open angle were observed in the CT to determine radiographic outcome. Demographic data were collected as well. Radiographic and clinical parameters were analyzed using univariate and multivariate logistic regression analysis to determine the risk factors for HF. Results : Univariate logistic regression analysis results indicated poor initial hinge status, medially placed hinge gutter, double screw fixation on the elevated lamina, upper surgical level, and wide open angle as predictors for HF (p<0.05). Initial hinge status seemed to be the most powerful risk factor for HF (p=0.000) and thus was collinear with other variables. Therefore, multivariate logistic regression analysis was performed excluding initial hinge status, and the results indicated that medially placed hinge gutter, double screw fixation on the elevated lamina, and upper surgical level were risk factors for HF after adjustment for other confounding factors. Conclusion : To prevent HF and to draw a successful postoperative outcome after cervical laminoplasty, surgical and clinical precautions should be considered.

Keywords

References

  1. Handa Y, Kubota T, Ishii H, Sato K, Tsuchida A, Arai Y : Evaluation of prognostic factors and clinical outcome in elderly patients in whom expansive laminoplasty is performed for cervical myelopathy due to multisegmental spondylotic canal stenosis. A retrospective comparison with younger patients. J Neurosurg 96 (2 Suppl) : 173-179, 2002
  2. Hirabayashi K, Satomi K : Operative procedure and results of expansive open-door laminoplasty. Spine (Phila Pa 1976) 13 : 870-876, 1988 https://doi.org/10.1097/00007632-198807000-00032
  3. 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) 8 : 693-699, 1983 https://doi.org/10.1097/00007632-198310000-00003
  4. Hosono N, Yonenobu K, Ono K : Neck and shoulder pain after laminoplasty. A noticeable complication. Spine (Phila Pa 1976) 21 : 1969-1973, 1996 https://doi.org/10.1097/00007632-199609010-00005
  5. Kawaguchi Y, Matsui H, Ishihara H, Gejo R, Yoshino O : Axial symptoms after en bloc cervical laminoplasty. J Spinal Disord 12 : 392-395, 1999 https://doi.org/10.1097/00002517-199912050-00007
  6. Lee SE, Chung CK, Kim CH, Jahng TA : Symmetrically medial bony gutters for open-door laminoplasty. J Spinal Disord Tech 26 : E101-E106, 2013 https://doi.org/10.1097/BSD.0b013e3182706b69
  7. Lee TT, Manzano GR, Green BA : Modified open-door cervical expansive laminoplasty for spondylotic myelopathy : operative technique, outcome, and predictors for gait improvement. J Neurosurg 86 : 64-68, 1997 https://doi.org/10.3171/jns.1997.86.1.0064
  8. O'Brien MF, Peterson D, Casey AT, Crockard HA : A novel technique for laminoplasty augmentation of spinal canal area using titanium miniplate stabilization. A computerized morphometric analysis. Spine (Phila Pa 1976) 21 : 474-483; discussion 484, 1996 https://doi.org/10.1097/00007632-199602150-00012
  9. Ohnari H, Sasai K, Akagi S, Iida H, Takanori S, Kato I : Investigation of axial symptoms after cervical laminoplasty, using questionnaire survey. Spine J 6 : 221-227, 2006 https://doi.org/10.1016/j.spinee.2005.10.014
  10. Park YK, Lee DY, Hur JW, Moon HJ : Delayed hinge fracture after plateaugmented, cervical open-door laminoplasty and its clinical significance. Spine J 14 : 1205-1213, 2014 https://doi.org/10.1016/j.spinee.2013.08.012
  11. Rhee JM, Register B, Hamasaki T, Franklin B : Plate-only open door laminoplasty maintains stable spinal canal expansion with high rates of hinge union and no plate failures. Spine (Phila Pa 1976) 36 : 9-14, 2011 https://doi.org/10.1097/BRS.0b013e3181fea49c
  12. Roselli R, Pompucci A, Formica F, Restuccia D, Di Lazzaro V, Valeriani M, et al. : Open-door laminoplasty for cervical stenotic myelopathy : surgical technique and neurophysiological monitoring. J Neurosurg 92 (1 Suppl) : 38-43, 2000
  13. Sakaura H, Hosono N, Mukai Y, Ishii T, Yoshikawa H : C5 palsy after decompression surgery for cervical myelopathy : review of the literature. Spine (Phila Pa 1976) 28 : 2447-2451, 2003 https://doi.org/10.1097/01.BRS.0000090833.96168.3F
  14. Satomi K, Nishu Y, Kohno T, Hirabayashi K : Long-term follow-up studies of open-door expansive laminoplasty for cervical stenotic myelopathy. Spine (Phila Pa 1976) 19 : 507-510, 1994 https://doi.org/10.1097/00007632-199403000-00003
  15. Satomi K, Ogawa J, Ishii Y, Hirabayashi K : Short-term complications and long-term results of expansive open-door laminoplasty for cervical stenotic myelopathy. Spine J 1 : 26-30, 2001 https://doi.org/10.1016/S1529-9430(01)00008-0
  16. Tsuji H : Laminoplasty for patients with compressive myelopathy due to so-called spinal canal stenosis in cervical and thoracic regions. Spine (Phila Pa 1976) 7 : 28-34, 1982 https://doi.org/10.1097/00007632-198200710-00002
  17. Wang MY, Shah S, Green BA : Clinical outcomes following cervical laminoplasty for 204 patients with cervical spondylotic myelopathy. Surg Neurol 62 : 487-492; discussion 492-493, 2004 https://doi.org/10.1016/j.surneu.2004.02.040

Cited by

  1. Factors related to infection after fixation in the process of late healed bone fracture vol.14, pp.2, 2016, https://doi.org/10.3892/etm.2017.4610
  2. Risk Factors for Hinge Fracture Associated with Surgery Following Cervical Open-Door Laminoplasty vol.14, pp.2, 2016, https://doi.org/10.13004/kjnt.2018.14.2.118