A Comparison of Implants Used in Open-Door Laminoplasty: Structural Rib Allografts Versus Metallic Miniplates
Ehsan Tabaraee1, Praveen Mummaneni, Amir Abdul-Jabbar
1*Department of Orthopaedic and Neurological Surgery, University of California, San Francisco, San Francisco, CA †Department of Orthopaedic Surgery, Louisiana State University, Baton Rouge, LA ‡University of Southern California, Los Angeles, CA §Department of Neurological Surgery, Loyola University Medical Center, Maywood, IL ∥Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA.
Study Design:
A retrospective case-controlled study.
Summary Of Background Data:
Open-door laminoplasty has been successfully used to address cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament. Two common implants include rib allograft struts and metallic miniplates.
Objective:
The goals of this study were to compare outcomes, complications, and costs associated with these 2 implants.
Methods:
A retrospective review was done on 51 patients with allograft struts and 55 patients with miniplates. Primary outcomes were neck visual analog scale (VAS) pain scores and Nurick scores. Secondary outcomes included length of the procedure, estimated blood loss, rates of complications, and the direct costs associated with the surgery and inpatient hospitalization.
Results:
There were no differences in demographic characteristics, diagnoses, comorbidities, and preoperative outcome scores between the 2 treatment groups. Mean follow-up was 27 months. The postoperative neck VAS scores and Nurick scores improved significantly from baseline to final follow-up for both groups, but there was no difference between the 2 groups. The average length of operation (161 vs. 136 min) and number of foraminotomies (2.7 vs. 1.3) were higher for the allograft group (P=0.007 and 0.0001, respectively). Among the miniplate group, there was no difference in complications but a trend for less neck pain for patients treated without hard collar at final follow-up (1.8 vs. 2.3, P=0.52). The mean direct costs of hospitalization for the miniplate group were 15% higher.
Conclusions:
Structural rib allograft struts and metallic miniplates result in similar improvements in pain and functional outcome scores with no difference in the rate of complications in short-term follow-up. Potential benefits of using a plate include shorter procedure length and less need for postoperative immobilization. When costs of bracing and operative time are included, the difference in cost between miniplates and allograft struts is negligible.
