Cervical posterior single-door laminoplasty versus double-door laminoplasty for cervical spondylotic myelopathy: a meta-analysis

doi:10.3969/j.issn.2095-4344.1056

Abstract

Abstract:

BACKGROUND: Whether treatment outcomes of single-door laminoplasty are different from double-door laminoplasty for cervical spondylotic myelopathy remains controversial. Even relevant meta-analysis obtains different conclusions.

OBJECTIVE: To systematically evaluate the efficacy and safety of cervical posterior single-door laminoplasty versus double-door laminoplasty in the treatment of cervical spondylotic myelopathy.

METHODS: Clinical trials of single-door laminoplasty versus double-door laminoplasty for cervical spondylotic myelopathy were retrieved. Literature screening, data extraction and literature evaluation were conducted by two researchers independently. The quality of the included randomized controlled trials was assessed with the bias risk assessment tool provided by Cochrane Collaborative Network. The quality of the retrospective studies was assessed with the Newcastle-Ottawa Scale score and meta-analysis was performed on RevMan 5.3 software.

RESULTS AND CONCLUSION: (1) A total of 14 articles were included, involving 893 patients. (2) The meta-analysis results showed that there were no significant differences in the Visual Analogue Scale scores [SMD=0.24, 95%CI (-0.64, 1.11), P=0.60], Japan Orthopaedic Association scores [SMD=0.15, 95%CI (-0.23, 0.52), P=0.44], Japan Orthopaedic Association recovery rate [MD=0.02, 95%CI (-0.02, 0.06), P=0.33], Nurick grade [SMD=-0.34, 95%CI (-0.73, 0.05), P=0.09], operation time [SMD=-0.21, 95%CI (-0.43, 0.02), P=0.07], blood loss [SMD=0.28, 95%CI (-0.20, 0.77), P=0.25], cervical lordosis [MD=0, 95%CI (-0.49, 0.77), P=1.00], range of motion [SMD=0.41, 95%CI (-0.48, 1.31), P=0.37] between two methods. (3) In terms of cervical canal enlargement rate, single-door laminoplasty was superior to double-door laminoplasty [MD=0.18, 95%CI (0.06, 0.30), P=0.003]. The postoperative complications of double-door laminoplasty were significantly lower than those of single-door laminoplasty [RR=1.5, 95%CI (1.04, 2.15), P=0.03], especially in postoperative pain symptoms [RR=6.35, 95%CI (1.93, 20.92), P=0.002]. (4) In summary, all clinical effects of cervical posterior double-door laminoplasty are similar to single-door laminoplasty, except for the few complications. But single-door laminoplasty can increase the spinal canal volume enlargement rate, so a large number of high-quality studies are needed to provide sufficient evidence.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Cervical Vertebrae, Vertebroplasty, Blood Loss, Surgical, Meta-Analysis, Tissue Engineering

CLC Number:

R459.5

Liang Long, Wei Xu, Zhu Liguo, Yin He, Yu Jie, Feng Minshan, Chen Lin. Cervical posterior single-door laminoplasty versus double-door laminoplasty for cervical spondylotic myelopathy: a meta-analysis[J]. Chinese Journal of Tissue Engineering Research, 2019, 23(8): 1299-1306.

Figures/Tables 6

2.4.4 Nurick分级共纳入3篇文献[10，13，9]，共119例患者。异质性分析显示存在一定的异质性(I2=66%) ，采用随机效应模型。结果显示单开门与双开门椎管成形术相比，两者差异无显著性意义[SMD=-0.34，95%CI(-0.73，0.05)，P=0.09]。表明在改善Nurick分级方面，尚不能判断2种术式是否存在差异，具体见图5。 2.4.5 手术时间共纳入6篇文献[9，13，15，19，22-23]，共322例患者。异质性分析显示异质性不明显(I2=5%)，采用固定效应模型。结果显示单开门与双开门椎管成形术相比，两者差异无显著性意义[SMD=-0.21，95%CI(-0.43，0.02)，P=0.07]。表明在手术时间方面，尚不能判断2种术式的差异，具体见图6。 2.4.6 出血量共纳入6篇文献[9，13，15，19，22-23]，共322例患者。异质性分析显示异质性明显(I2=86%)，采用随机效应模型。结果显示单开门与双开门椎管成形术相比，两者差异无显著性意义[SMD=0.28，95%CI(-0.20，0.77)，P=0.25]。表明2种术式在术中出血量方面差异不明显，见图7。 2.4.7 颈椎曲度共纳入4篇文献[9-10，13-14]，共296例患者。首先进行异质性检验，显示2组存在异质性(I2=83%)，采用随机效应模型。结果显示单开门与双开门椎管成形术相比，两者差异无显著性意义[MD=0，95%CI(-0.49，0.77)，P=1.00]。表明2种术式在改善颈椎曲度方面疗效差异不明显，见图8。 2.4.8 颈椎活动度共有7篇文献提到2种术式对颈椎活动度的改善情况[9，13-14，18-20，22]。共纳入505例患者。各研究组间统计学上存在异质性(I2=95%)，故选用随机效应模型进行统计分析，并根据研究类型的不同进行分组。分析结果显示，Z=0.90，[SMD=0.41，95%CI (-0.48，1.31)]，P=0.37，无论国内研究还是国外研究均表明2种术式对颈椎活动度的改善效果差异无显著性意义，见图9。 2.4.9 椎管容积增加率共纳入2篇文献[9，24]，共124例患者。首先进行异质性检验，显示2组存在异质性(I2=0%)，采用固定效应模型。结果显示单开门与双开门椎管成形术相比，两者差异有显著性意义[MD=0.18，95%CI(0.06，0.30)，P=0.003]。表明单开门椎管成形术更能增加椎管内的容积，见图10。"

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