Clinical outcomes effect of preserving the unilateral muscle-ligament complex in open-door laminoplasty: a Meta analysis

English Keywords:Laminoplasty  Muscle-ligament complex  Meta analysis

English Abstract:

  【Abstract】 Objectives: To explore the clinical effect of modified laminoplasty with preservation of unilateral muscle-ligament complex using Meta-analysis. Methods: The databases of PubMed, Web of Science, Embase, Cochrane, CNKI(China National Knowledge Infrastructure), Wanfang, Weipu, and CBM CBM were searched, and studies of laminoplasty that preserved the unilateral muscle and ligament complex(modified group) and of laminoplasty that did not preserve the unilateral muscle and ligament(traditional group) were screened out. The postoperative VAS score, postoperative cervical spine dysfunction index(neck disability index, NDI), the incidence of postoperative axial pain, postoperative cervical curvature index, postoperative cervical spine mobility,postoperative cervical sagittal vertical distance(cSVA), postoperative C5 nerve root paralysis, postoperative JOA score and other indicators were recorded. The extracted data was analyzed by Revman 5.3.0. Among them, we used the odds ratio(OR) as the synthetic statistics for the binary variable data, and the standardized mean difference(SMD) as the synthetic statistics for the continuous variable data. Finally, the pros and cons of the modified group were evaluated by the above. Results: In the end, a total of 11 articles and a total of 905 patients were included in this study. The operation time of the modified group[SMD=1.06, 95%CI(0.20, 1.92), P=0.02] was longer, intraoperative blood loss[SMD=0.56, 95%CI(0.40, 1.09), P=0.04] was more. Of the modified group, the postoperative VAS score one year later[SMD=-1.39, 95%CI(-1.98, -0.80), P=0.00001] and NDI score[SMD=-0.51, 95%CI(-0.69, -0.33), P<0.00001] were smaller than those of the traditional group, and the incidence rates of postoperative axial pain one year later[OR=0.42, 95%CI(0.26, 0.67), P=0.003] was lower. Besides, the postoperative cervical curvature index two years later[SMD=0.96, 95%CI(0.68, 1.24), P<0.00001], and cervical spine mobility one year later[SMD=0.85, 95%CI(0.64, 1.06), P<0.00001] of the modified group was greater than those of the traditional group, while cSVA one year later[SMD=-2.33, 95%CI(-3.84, -0.81), P=0.003] was shorter than the latter. The incidence of C5 nerve root paralysis one year later be`tween the two groups[OR=0.44, 95%CI(0.18, 1.06), P=0.07] and postoperative JOA score one year later[SMD=0.09, 95%CI(-0.22, 0.40), P=0.58] showed no statistical difference. Conclusions: The modified operation that preserves the unilateral muscle-ligament complex has certain advantages in reducing the incidence of postoperative axial pain, protecting the cervical spine movement function, and maintaining the normal sagittal sequence, however, compared with the traditional group, the operation time is longer and the intraoperative blood loss is more.