{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T03:38:47Z","timestamp":1788233927352,"version":"build-2803163510"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,1,15]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>In the setting of cervical open-door laminoplasty, the question of whether or not every opened laminar level should be instrumented has not been sufficiently investigated. We postulated that the surgical outcomes of open-door laminoplasty with instrumentation of every second opened level (skip-fixation) might not be inferior to those of laminoplasty with instrumentation of every opened level (all-fixation). The purpose of the present study was to test the noninferiority of laminoplasty with skip-fixation in improving myelopathy at 2 years postoperatively compared with all-fixation. Additionally, we compared radiographic and surgical outcomes between the 2 types of procedures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This prospective, multicenter, unblinded randomized controlled trial included patients \u226560 years of age who underwent C3 to C6 open-door cervical laminoplasty for the treatment of degenerative cervical myelopathy. Patients were allocated to the skip-fixation group (n = 80) or the all-fixation group (n = 75) using a permuted block method. The primary outcome was the between-group difference in the Japanese Orthopaedic Association (JOA) score at 2 years postoperatively. Secondary outcomes included surgical data, complications, 2-year change in the JOA score, Neck Disability Index (NDI), EQ-5D-5L (EuroQol 5-dimension 5-level instrument) score, visual analog scale (VAS) score for neck pain, and radiographic outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>One hundred and thirty patients (including 66 in the skip-fixation group and 64 in the all-fixation group) completed the trial at 2 years (follow-up rate, 83.9%). The difference in the JOA score at 2 years was 0.0298 (95% confidence interval [CI], \u22120.706 to 0.766), which was within the noninferiority margin (p &lt; 0.0001; noninferiority test). In the secondary analyses, laminoplasty with skip-fixation demonstrated a significantly shorter surgical time (p = 0.010; Mann-Whitney U test) and greater improvement in the VAS score for neck pain, NDI, and EQ-5D-5L score (p = 0.006, p = 0.047, p = 0.037, respectively; mixed-effect model) compared with all-fixation. There were no significant between-group differences in radiographic outcomes, including the hinge union rate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Skip-fixation may be sufficient to achieve noninferior 2-year postoperative improvement in myelopathy. Additionally, laminoplasty with skip-fixation potentially can lead to improvements in terms of neck pain, neck disability, and quality of life compared with all-fixation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level II<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.24.00245","type":"journal-article","created":{"date-parts":[[2024,11,21]],"date-time":"2024-11-21T14:01:14Z","timestamp":1732197674000},"page":"144-151","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":5,"title":["Open-Door Cervical Laminoplasty Using Instrumentation of Every Level Versus Alternate Levels"],"prefix":"10.2106","volume":"107","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1467-2599","authenticated-orcid":false,"given":"Koji","family":"Tamai","sequence":"first","affiliation":[{"name":"Department of Orthopedics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9183-3363","authenticated-orcid":false,"given":"Hidetomi","family":"Terai","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2122-1082","authenticated-orcid":false,"given":"Masaki","family":"Terakawa","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Osaka General Hospital of West Railway Company, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6906-5406","authenticated-orcid":false,"given":"Shinji","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4800-9226","authenticated-orcid":false,"given":"Akinobu","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5380-5000","authenticated-orcid":false,"given":"Hiroaki","family":"Nakamura","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,11,21]]},"reference":[{"issue":"12","key":"bib1-20250405","doi-asserted-by":"crossref","first-page":"E675","DOI":"10.1097\/BRS.0000000000000913","article-title":"Degenerative cervical myelopathy: epidemiology, genetics, and pathogenesis","volume":"40","author":"Nouri","year":"2015","journal-title":"Spine (Phila Pa 1976)."},{"issue":"3","key":"bib2-20250405","doi-asserted-by":"crossref","first-page":"E116","DOI":"10.1503\/cmaj.151478","article-title":"Degenerative cervical myelopathy","volume":"189","author":"Witiw","year":"2017","journal-title":"CMAJ."},{"issue":"4","key":"bib3-20250405","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1097\/00007632-198107000-00005","article-title":"Operative results and postoperative progression of ossification among patients with ossification of cervical posterior longitudinal ligament","volume":"6","author":"Hirabayashi","year":"1981","journal-title":"Spine (Phila Pa 1976)."},{"key":"bib4-20250405","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1097\/00003086-199902000-00005","article-title":"Expansive laminoplasty for myelopathy in ossification of the longitudinal ligament","volume":"359","author":"Hirabayashi","year":"1999","journal-title":"Clin Orthop Relat Res."},{"issue":"5","key":"bib5-20250405","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1097\/00007632-199403000-00003","article-title":"Long-term follow-up studies of open-door expansive laminoplasty for cervical stenotic myelopathy","volume":"19","author":"Satomi","year":"1994","journal-title":"Spine (Phila Pa 1976)."},{"issue":"5","key":"bib6-20250405","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1097\/00007632-200103010-00010","article-title":"Long-term results of double-door laminoplasty for cervical stenotic myelopathy","volume":"26","author":"Seichi","year":"2001","journal-title":"Spine (Phila Pa 1976)."},{"issue":"3","key":"bib7-20250405","doi-asserted-by":"crossref","first-page":"E7","DOI":"10.3171\/foc.2003.15.3.7","article-title":"Laminoplasty for the treatment of failed anterior cervical spine surgery","volume":"15","author":"Wang","year":"2003","journal-title":"Neurosurg Focus."},{"issue":"10","key":"bib8-20250405","doi-asserted-by":"crossref","first-page":"942","DOI":"10.1001\/jama.2021.1233","article-title":"Effect of ventral vs dorsal spinal surgery on patient-reported physical functioning in patients with cervical spondylotic myelopathy: a randomized clinical trial","volume":"325","author":"Ghogawala","year":"2021","journal-title":"JAMA."},{"issue":"7","key":"bib9-20250405","doi-asserted-by":"crossref","first-page":"1089","DOI":"10.2106\/00004623-199707000-00019","article-title":"The conduct of orthopaedic clinical trials","volume":"79","author":"Fuson","year":"1997","journal-title":"J Bone Joint Surg Am."},{"issue":"26","key":"bib10-20250405","doi-asserted-by":"crossref","first-page":"E990","DOI":"10.1097\/BRS.0b013e318188b300","article-title":"A new concept for making decisions regarding the surgical approach for cervical ossification of the posterior longitudinal ligament: the K-line","volume":"33","author":"Fujiyoshi","year":"2008","journal-title":"Spine (Phila Pa 1976)."},{"issue":"7","key":"bib11-20250405","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1097\/00007632-198310000-00003","article-title":"Expansive open-door laminoplasty for cervical spinal stenotic myelopathy","volume":"8","author":"Hirabayashi","year":"1983","journal-title":"Spine (Phila Pa 1976)."},{"key":"bib12-20250405","first-page":"490","article-title":"Revised Japanese Orthopaedic Association scores for cervical myelopathy","volume":"68","year":"1994","journal-title":"J Jpn Orthop Assoc,"},{"issue":"3","key":"bib13-20250405","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1302\/0301-620X.92B3.22786","article-title":"C5 palsy after cervical laminoplasty: a multicentre study","volume":"92","author":"Imagama","year":"2010","journal-title":"J Bone Joint Surg Br."},{"issue":"14","key":"bib14-20250405","doi-asserted-by":"crossref","first-page":"1601","DOI":"10.1097\/01.BRS.0000077510.95462.39","article-title":"Association of the Japanese Orthopaedic Association score with the Oswestry Disability Index, Roland-Morris Disability Questionnaire, and Short-Form 36","volume":"28","author":"Fujiwara","year":"2003","journal-title":"Spine (Phila Pa 1976)."},{"issue":"8","key":"bib15-20250405","first-page":"271","article-title":"The Oswestry Low Back Pain Disability Questionnaire","volume":"66","author":"Fairbank","year":"1980","journal-title":"Physiotherapy."},{"issue":"10","key":"bib16-20250405","doi-asserted-by":"crossref","first-page":"1727","DOI":"10.1007\/s11136-011-9903-x","article-title":"Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L)","volume":"20","author":"Herdman","year":"2011","journal-title":"Qual Life Res."},{"issue":"3","key":"bib17-20250405","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1007\/s11136-015-1108-2","article-title":"Japanese population norms for preference-based measures: EQ-5D-3L, EQ-5D-5L, and SF-6D","volume":"25","author":"Shiroiwa","year":"2016","journal-title":"Qual Life Res."},{"issue":"5","key":"bib18-20250405","doi-asserted-by":"crossref","first-page":"648","DOI":"10.1016\/j.jval.2016.03.1834","article-title":"Comparison of value set based on DCE and\/or TTO data: scoring for EQ-5D-5L health states in Japan","volume":"19","author":"Shiroiwa","year":"2016","journal-title":"Value Health."},{"issue":"3","key":"bib19-20250405","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1227\/NEU.0b013e31826100c9","article-title":"ISSG. The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery","volume":"71","author":"Tang","year":"2012","journal-title":"Neurosurgery."},{"issue":"7","key":"bib20-20250405","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1097\/BRS.0000000000002371","article-title":"Can C7 Slope Substitute the T1 slope?: An Analysis Using Cervical Radiographs and Kinematic MRIs","volume":"43","author":"Tamai","year":"2018","journal-title":"Spine (Phila Pa 1976)."},{"issue":"1","key":"bib21-20250405","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1097\/BRS.0b013e3181fea49c","article-title":"Plate-only open door laminoplasty maintains stable spinal canal expansion with high rates of hinge union and no plate failures","volume":"36","author":"Rhee","year":"2011","journal-title":"Spine (Phila Pa 1976)."},{"issue":"10","key":"bib22-20250405","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1097\/BRS.0000000000002928","article-title":"Minimum clinically important difference and patient acceptable symptom state of Japanese Orthopaedic Association Score in degenerative cervical myelopathy patients","volume":"44","author":"Kato","year":"2019","journal-title":"Spine (Phila Pa 1976)."},{"issue":"1","key":"bib23-20250405","doi-asserted-by":"crossref","first-page":"8","DOI":"10.22603\/ssrr.2019-0023","article-title":"Development and achievement of cervical laminoplasty and related studies on cervical myelopathy","volume":"4","author":"Hirabayashi","year":"2019","journal-title":"Spine Surg Relat Res."},{"issue":"9","key":"bib24-20250405","doi-asserted-by":"crossref","first-page":"1062","DOI":"10.1016\/j.spinee.2016.04.018","article-title":"Laminar closure after expansive open-door laminoplasty: fixation methods and cervical alignments impact on the laminar closure and surgical outcomes","volume":"16","author":"Tamai","year":"2016","journal-title":"Spine J."},{"issue":"22","key":"bib25-20250405","doi-asserted-by":"crossref","first-page":"2544","DOI":"10.1097\/01.brs.0000186332.66490.ba","article-title":"Axial symptoms after cervical laminoplasty with C3 laminectomy compared with conventional C3-C7 laminoplasty: a modified laminoplasty preserving the semispinalis cervicis inserted into axis","volume":"30","author":"Takeuchi","year":"2005","journal-title":"Spine (Phila Pa 1976)."},{"issue":"1","key":"bib26-20250405","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1055\/s-0033-1341606","article-title":"Neck pain following cervical laminoplasty: Does preservation of the C2 muscle attachments and\/or C7 matter?","volume":"4","author":"Riew","year":"2013","journal-title":"Evid Based Spine Care J."},{"issue":"18","key":"bib27-20250405","doi-asserted-by":"crossref","first-page":"1651","DOI":"10.2106\/JBJS.L.00589","article-title":"Efficacy and safety of surgical decompression in patients with cervical spondylotic myelopathy: results of the AOSpine North America prospective multi-center study","volume":"95","author":"Fehlings","year":"2013","journal-title":"J Bone Joint Surg Am."},{"issue":"5","key":"bib28-20250405","doi-asserted-by":"crossref","first-page":"E303","DOI":"10.1097\/BRS.0000000000003787","article-title":"Time course of physical and mental well-being improvements after cervical surgery","volume":"46","author":"Tamai","year":"2021","journal-title":"Spine (Phila Pa 1976)."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.24.00245","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:48:27Z","timestamp":1787752107000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.24.00245"}},"subtitle":["A Multicenter, Randomized Controlled Trial"],"short-title":[],"issued":{"date-parts":[[2024,11,21]]},"references-count":28,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.24.00245","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,21]]}}}