Mini-plate fixation versus suture suspensory fixation in cervical laminoplasty

BACKGROUND Both the mini-plate fixation and suture suspensory fixation techniques are extensively applied in cervical laminoplasty, but which technique is superior has not been ascertained. The purpose of this meta-analysis is to compare the results between mini-plate fixation and suture suspensory fixation in cervical laminoplasty for the patients with multilevel cervical compressive myelopathy. METHODS PubMed, Embase, the Cochrane library, CNKI, and WANFANG were searched for studies that compared mini-plate fixation and suture suspensory fixation in cervical laminoplasty up to November 1, 2016. We calculated odds ratio (OR) with 95% confidence interval (CI) for dichotomous outcomes and mean difference (MD) with 95% CI for continuous outcomes. Review Manager 5.3 was used for the statistical analyses. RESULTS A total of 25 studies, involving 1603 participants, were included in this review. The results of this meta-analysis indicated that there were statistically significant differences in postoperative Japanese Orthopedic Association (JOA) scores (MD = 0.67, 95% CI: 0.34-0.99, P < 0.001), JOA scores improvement rate (MD = 4.00, 95% CI: 2.51-5.50, P < 0.001), postoperative Visual Analogue Score (VAS) (MD = -0.81, 95% CI: -1.36 to -0.26, P = 0.004), postoperative range of motion (ROM) (MD = 4.15, 95% CI: 2.06-6.23, P < 0.001), postoperative cervical lordosis (MD = 3.1, 95% CI: 2.02-4.18, P < 0.001), postoperative anteroposterior diameter of the spinal canal (MD = 1.53, 95% CI: 0.11-2.95, P = 0.03), postoperative open angle (MD = 1.93, 95% CI: 0.14-3.71, P = 0.03), postoperative cross-sectional area of the spinal canal (MD = 37.10, 95% CI: 26.92-47.29, P < 0.001), axial symptoms (OR = 0.28, 95% CI: 0.20-0.37, P < 0.001), operation time (MD = 4.46, 95% CI: 0.74-8.19, P = 0.02), and blood loss (MD = 9.24, 95% CI: 6.86-11.62, P < 0.001). However, there was no statistically significant difference in C5 palsy (OR = 0.82, 95% CI: 0.37-1.84, P = 0.63). CONCLUSIONS As compared with suture suspensory fixation, mini-plate fixation in cervical laminoplasty appears to achieve better clinical and radiographic outcomes with fewer surgical complications. However, mini-plate fixation is associated with bigger surgical trauma. This conclusion should be interpreted cautiously and more high-quality, randomized controlled trials are needed in the future.