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All-Level Versus Alternative-Level in Unilateral Laminoplasty: A Retrospective Comparative Study
Bin Zheng1, Zhenqi Zhu1, Yan Liang1
1Spine Surgery, Peking University People's Hospital, Beijing, China.
Orthopaedic Surgery
|June 9, 2025
Summary
Alternative-level fixation in cervical laminoplasty offers similar clinical outcomes to all-level fixation for multilevel cervical spondylotic myelopathy (CSM), with reduced costs. However, all-level fixation better preserves spinal canal diameter long-term.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Spinal Surgery
Background:
- Unilateral open-door laminoplasty utilizes titanium mini-plates to secure elevated laminae in cervical spondylotic myelopathy (CSM).
- Conventional techniques fixate every level, while alternative strategies plate only select levels to reduce implant costs.
- The long-term efficacy and safety of alternative-level fixation compared to all-level fixation remain under investigation.
Purpose of the Study:
- To compare the clinical and radiographic efficacy and safety of alternative-level versus all-level fixation in cervical laminoplasty for multilevel CSM.
- To evaluate the impact of fixation strategy on patient outcomes, including neurological function, pain, and spinal alignment.
Main Methods:
- Retrospective analysis of 65 patients undergoing C3-C7 unilateral laminoplasty.
- Patients were divided into alternative-level fixation and all-level fixation groups.
- Clinical outcomes (operative time, blood loss, hospitalization, complications, JOA score, VAS) and radiographic outcomes (APD, Pavlov ratio, CL, T1S, SVA) were assessed.
Main Results:
- Both groups demonstrated significant postoperative improvements in Japanese Orthopaedic Association (JOA) scores and Visual Analog Scale (VAS) for pain, with no statistically significant differences between fixation strategies.
- Alternative-level fixation resulted in significantly lower total hospital costs.
- All-level fixation showed better long-term preservation of the anterior-posterior diameter (APD) of the spinal canal.
Conclusions:
- Both all-level and alternative-level fixation effectively support the lamina and prevent reclosure in cervical laminoplasty.
- There were no significant differences in postoperative clinical outcomes or sagittal parameters between the two fixation methods.
- All-level fixation demonstrated superior long-term preservation of spinal canal diameter compared to alternative-level fixation.
