Is Mini-Plate Fixation Superior to Suture Suspensory Fixation in Cervical Laminoplasty? A Meta-Analysis.

BACKGROUND: Owing to the small sample sizes in individual studies reported to date, whether or not mini-plate fixation is better than suture suspensory fixation in unilateral open-door laminoplasty is unclear. Thus, we conducted a meta-analysis to evaluate which fixation method is superior in cervical laminoplasty for patients with multilevel cervical spondylotic myelopathy (MCSM).

METHODS: Several electronic databases were selected to search the related studies. The main endpoints included operation time, blood loss, preoperative Japanese Orthopedic Association (JOA) score, postoperative JOA score, JOA recovery rate, postoperative anteroposterior diameter, open angle, and the incidence of axial symptoms or C5 palsy after surgery. The results are presented as mean difference (MD) for continuous outcomes and odds ratio (OR) with 95% confidence interval (CI) for dichotomous outcomes.

RESULTS: Six studies, including a total of 436 patients, were included in this review. The postoperative JOA score was higher in patients receiving suture suspensory fixation (group B) than in those receiving mini-plate fixation (group A) (MD, 0.51; 95% CI, 0.07-0.96; P = 0.002), as was the incidence of C5 palsy (OR, 0.37; 95% CI, 0.15-0.92; P = 0.03). In 5 of the 6 studies, including 282 patients, the incidence of axial symptoms was lower in group A (OR, 0.37; 95% CI, 0.21-0.67; P = 0.0009). There were no significant differences (P > 0.05) between groups A and B in terms of operation time, blood loss, JOA recovery rate, postoperative anteroposterior diameter, or open angle after surgery.

CONCLUSIONS: Although suture suspensory fixation was associated with better postoperative JOA scores, mini-plate fixation was superior in reducing the incidence of surgical complications. To avoid severe surgical complications, mini-plate fixation is a good choice for laminoplasty for patients with MCSM. Valid evidence depends on more high-quality, randomized controlled trials in the future.