Relationship between hinge fracture and postoperative axial symptoms after cervical laminoplasty

Abstract

Objective

To identify the clinical characteristics of fractured hinges after open-door cervical laminoplasty for cervical canal stenosis and explore the relationship between hinge fractures and axial symptoms.

Methods

This was a retrospective study of patients with cervical myelopathy who underwent open-door laminoplasty between November 2014 and November 2016 at the Affiliated Hospital of Qingdao University. Cervical CT scans were performed after surgery and the Takeuchi criteria were applied to evaluate the postoperative axial symptoms.

Results

Of 223 opened laminae in 67 patients, 67 laminae (30.0%) in 30 patients (44.8%) showed fracture. The frequency of hinge fractures was higher at C6 (53.7%). Forty-nine fractured laminae (73.13%) were non-displaced and 18 were displaced. At 3 months, 33 fractured laminae (49.3%) showed bony union on CT, and union rates were 86.6% and 91.0% at 6 and 12 months, respectively, indicating that the union rate was lower for displaced fractures than for non-displaced fractures. Among the 67 patients, 14 had axial symptoms: three of 37 (8.1%) patients without hinge fractures and 11 of 30 (36.7%) patients with hinge fractures. One year later, the hinge fractures were healed in 24/30 patients. Among the six unhealed patients, five still suffered from axial symptoms. The frequency of axial symptoms was higher in the patients with three or more hinge fractures (66.7%) than in the patients with only one (16.7%) or two (46.7%) hinge fractures.

Conclusions

Patients with hinge fractures may have an increased risk for axial symptoms after open-door cervical laminoplasty. The frequency of axial symptoms decreases with fracture healing.

Keywords:

• Hinge fracture
• axial symptoms
• cervical laminoplasty
• clinical characteristics
• retrospective study

Ethical approval

The study was approved by the Ethics Committee of the Affiliated Hospital of Qingdao University and all participants provided written informed consent.

Author contributions

Xuexiao Ma, Chuanli Zhou and Hao Tao contributed to the project design and overall planningimplementation. Derong Xu was responsible for article writing and data collection. Mengxiong Song and Chen Peng contributed to the literature collection and data statistics. Xuexiao Ma, Kai Zhu and Chao Wang participated in draft the manuscript and review-revised manuscript. Hao Zhang is responsible for assisting in the drawing and tabulation of the article modification, retouching and correction. All authors have read and approved the final manuscript.

Disclosure statement

The authors report no conflict of interest.

Data availability statement

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Additional information

Funding

This work was supported by the National Natural Science Foundation of China under Grant No. [81871804 and. 81672200].