Comparative Effectiveness Of Open-door Laminoplasty Modified By The Use Of Titanium Miniplating Versus Double-door Laminoplasty Modified By The Application Of Threadwire Saw For The Treatment Of Multilevel Cervical Compressive Myelopathy

Objective: The starting point of our study was to compare the efficacy of open-door cervical laminoplasty versus double-door cervical laminoplasty in the treatment of multilevel cervical compressive myelopathy using systematic review and meta-analytic techniques,in which we found there was little controlled study of large sample and high quality and the original document was unevenly distribute.The meta-analytic result is biased significantly and the original document’s conclusion is very different because different articals use the different modified operation of open-door cervical laminoplasty and double-door cervical laminoplasty.The clinical data of open-door cervical laminoplasty and double-door cervical laminoplasty collected from our hospital were analyzed to compare the efficacy of open-door laminoplasty modified by the use of titanium miniplating versus double-door laminoplasty modified by the application of threadwire saw in the treatment of multilevel cervical compressive myelopathy,so we could provide reference data for meta-analysis and clinical treatment.Methods: This study is an ambispective cohort study,in which the clinical data of open-door laminoplasty modified by the use of titanium miniplating and double-door laminoplasty modified by the application of threadwire saw in the treatment of multilevel cervical compressive myelopathy were collected from the First Affiliated Hospital of Dalian Medical University between June 2005 and June 2013.Relevant data were critically extracted to synthetical analysis the surgical result on operation parameters(surgical duration,intraoperative blood loss and postoperative drainage volume),postoperative complications(infections,axial symptom,and C5 palsy),radiological evaluation(cervical lordotic angles,extension angle,flexion angle and range of motion)and neurological condition(Nurick Grade and JOA score).Results: 60 multilevel cervical compressive myelopathy patients involving43 patients for open-door laminoplasty modified by the use of titanium miniplating(3 lost follow-up)and 17 patients for double-door laminoplasty modified by the application of threadwire saw(2 lost follow-up)were receive treatment by 3 well-experienced surgeon with a focus on the neurological and postoperative radiological outcomes.The results showed that,compared open-door cervical laminoplasty with double-door cervical laminoplasty,there were no statistical significance in operation parameters(surgical duration,intraoperative blood loss and postoperative drainage volume),postoperative complications(infections,axial symptom,C5 palsy),radiological evaluation(cervical lordotic angles,extension angle,flexion angle and range of motion)and neurological condition(Nurick Grade and JOA score)(P>0.05).However,people with good neurological condition always well prognosis.Conclusion: In our view,open-door laminoplasty modified by the use of titanium miniplating for the treatment multilevel cervical compressive myelopathy is as well as double-door laminoplasty modified by the application of threadwire saw in regards to the rate of postoperative good Nurick grades and JOA scores.But never arrive at a conclusion in haste until we have made further investigation and deeper analysis with randomized controlled study of large sample and high quality in the future,which will be our next study.Certainly,the different operation methods were selected according to patients condition,surgeons experience and preference until there was enough evide.In spinal cord injury(SCI),axonal disruption results in motor and sensory function impairment.Unfortunately,there’s no effective treatment in clinic by now.We noticed that collagen-binding vascular endothelial growth factor(CBD-VEGF)are being widely applied in the recovery of myocardial infarction,scarred rat uterus following full-thickness injury,diabetic wound and motoneuron degeneration.The embodiment of their common ground to repair injured tissues was the improvement of microcirculation or nerve regeneration.However,no CBD-VEGF has been reported in SCI regions.Thus,it was hypothesized that a functional biomaterials including CBD-VEGF and linear ordered collagen scaffolds(LOCS)are used to repair SCI.The main reason for selecting LOCS was that it not only showed good CBD-VEGF adhesion and controlled delivery but also provided a supportive substrate for neurite extension.Locomotor function was assessed using the BBB(Basso,Beattie,and Bresnahan)scale,immunohistochemical staining analyses with anti-neurofilament antibody quantified nerve axon area of the lump defect site,and DTI detect change of white matter at the level of injury.We found that rats that received LOCS loaded with CBD-VEGF exhibited significantly improved recovery of locomotor function,a greater area of nerve axon and a more integrated traced tracts as compared to rats treated with LOCS loaded with PBS or untreated controls.So,this targeting drug delivery system consisting of CBD-VEGF and LOCS could be an effective strategy for promoting axonal regeneration or improving motor function in the repair of SCI.