title: All levels versus alternate levels plate fixation in expansive open door cervical laminoplasty.
abstract: BACKGROUND
  Expansive open door laminoplasty with the use of titanium miniplate is becoming popular. Usually, the plate is applied at each level to prevent re-closure of the opened lamina. However, it is also used at alternating levels (i.e., C3, C5 and C7) in clinical settings in order to reduce the cost. Whether they have any difference in clinical efficacy? There is a lack of comparative data between the two kinds of plate fixation in the literature.
  
  
  METHODS
  83 patients who underwent cervical laminoplasty with alternating levels plate fixation (51 patients in Group A) or all levels plate fixation (32 patients in Group B) between January 2008 and October 2012 were evaluated in our institute retrospectively. Clinical and radiologic outcomes were assessed.
  
  
  RESULTS
  No statistical difference was found in the mean operation time, blood loss, incidence of significant axial symptoms and C5 palsy, preoperative anteroposterior diameter (APD) and preoperative Japanese Orthopedic Association score between the two groups. However, Group B showed a higher rate of neurologic recovery after surgery. Postoperative increased APD and open angle in Group B were significantly larger than Group A. The mean cost for Group B (12801 ± 460.6 USD) was higher than Group A (8906 ± 566.7 USD).
  
  
  CONCLUSIONS
  Despite the higher cost of all level fixation, it is more effective in maintaining the expansion of the spinal canal and can obtain better clinical improvement compared to alternating levels fixation.
authors.affiliation: Department of Orthopedics, 1 Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China ; Department of Orthopedics, Changshu No. 1 People's Hospital, Changshu 215500, Jiangsu Province, China.
authors.forename: Zheng-Fei
authors.initials: ZF
authors.lastname: Wang
authors.affiliation: Department of Orthopedics, 1 Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China.
authors.forename: Guang-Dong
authors.initials: GD
authors.lastname: Chen
authors.affiliation: Department of Orthopedics, Changshu No. 1 People's Hospital, Changshu 215500, Jiangsu Province, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Xue
authors.affiliation: Department of Orthopedics, Changshu No. 1 People's Hospital, Changshu 215500, Jiangsu Province, China.
authors.forename: Xiao-Wen
authors.initials: XW
authors.lastname: Sheng
authors.affiliation: Department of Orthopedics, 1 Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China.
authors.forename: Hui-Lin
authors.initials: HL
authors.lastname: Yang
authors.affiliation: Department of Orthopedics, 1 Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Qian
keywords: Cervical myelopathy; Spinal cord compression; cervical vertebrae; compressive; laminoplasty; myelopathy; open door