Open-Door Cervical Laminoplasty Using Instrumentation of Every Level Versus Alternate Levels: A Multicenter,...

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Spinal Surgery

Background:

• Cervical open-door laminoplasty is a common procedure for degenerative cervical myelopathy.
• The necessity of instrumenting every opened laminar level remains unclear.
• Skip-fixation (instrumenting every second level) is proposed as a potentially less invasive alternative.

Purpose of the Study:

• To test the non-inferiority of skip-fixation versus all-fixation in improving Japanese Orthopaedic Association (JOA) scores at 2 years post-surgery.
• To compare surgical outcomes, complications, and radiographic results between the two fixation methods.

Main Methods:

• Prospective, multicenter, unblinded randomized controlled trial.
• Inclusion of patients aged 60+ undergoing C3-C6 open-door cervical laminoplasty.
• Allocation to either skip-fixation (n=80) or all-fixation (n=75) groups.

Main Results:

• Skip-fixation demonstrated non-inferiority in JOA score improvement at 2 years (difference = 0.0298).
• Significantly shorter surgical time in the skip-fixation group (p=0.010).
• Greater improvements in neck pain (VAS), neck disability (NDI), and quality of life (EQ-5D-5L) with skip-fixation.

Conclusions:

• Skip-fixation appears sufficient for achieving non-inferior myelopathy improvement after cervical laminoplasty.
• Skip-fixation may offer advantages in reducing neck pain, disability, and enhancing quality of life compared to all-fixation.