Comparison of three fixation modalities for unilateral open-door cervical laminoplasty: a systematic review and network meta-analysis

Three fixation modalities including suture suspensory, anchor, and titanium plate are used extensively in unilateral open-door cervical laminoplasty. Nevertheless, up to now no systematic review and network meta-analysis have been published, and the differences in efficacy and safety of the three fixation modalities are still unclear. The purpose of this study is to compare the effectiveness and safety of the three fixation modalities including suture suspensory, anchor, and titanium plate in unilateral open-door cervical laminoplasty. Randomized controlled trials and cohort studies which compared the three interventions in unilateral open-door cervical laminoplasty were identified using the following databases: PubMed, Cochrane Library, Embase, Web of science, China National Knowledge Infrastructure, Chinese Science and Technology Periodical Database, and Wanfang data. Network meta-analysis was performed using R 3.4.3 software and STATA version 14.0. The results revealed that compared with suture suspensory, titanium plate and anchor showed the same effects in Japanese Orthopedic Association Scores, operative time, and blood loss. However, titanium plate showed superiority in postoperative range of motion of cervical spine, incidence of axial symptoms, and C5 paralysis; in terms of cervical curvature, titanium plate also showed better effectiveness than suture suspensory, but similar as anchor. Our network meta-analysis suggests that titanium plate is preferable to suture suspensory or anchor with more range of motion and lower incidence of axial symptoms and C5 paralysis. However, considering the limitations of this research, high-quality trials are needed in the future to evaluate the outcomes.