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Objective <p>To evaluate the clinical efficacy and safety of a "Pre-set Screw Path Technique (PSPT)” compared with the traditional drilling method in cervical posterior open-door laminoplasty with titanium plate fixation.</p> Methods <p>In this prospective randomized controlled trial, 113 patients with multilevel cervical spondylotic myelopathy undergoing C3–C7 laminoplasty (February 2019–February 2023) were allocated to either the control group (<i>n</i> = 58, traditional drilling) or the experimental group (<i>n</i> = 55, pre-set screw path technique). The primary outcome was the incidence of intraoperative spinal cord or nerve root injury related to drilling. Secondary outcomes included operative duration, intraoperative blood loss, neurological recovery [Japanese Orthopaedic Association (JOA) score and improvement rate at 1 week, 3, 6, and 12 months], cervical range of motion (ROM), axial symptoms, and other complications (screw loosening, dural tear, C5 palsy, etc.).</p> Results <p>For the primary endpoint, no spinal cord or nerve root injury occurred in the experimental group (0/55), while one transient nerve root irritation was observed in the control group (1/58, 1.72%); the difference was not statistically significant (<i>P</i> = 0.328). Secondary outcomes showed that the experimental group had significantly shorter operative time (86.07 ± 21.97 vs. 106.29 ± 47.56&#xa0;min, <i>P</i> &lt; 0.05), reduced blood loss (111.09 ± 35.21 vs. 168.19 ± 97.35&#xa0;ml, <i>P</i> &lt; 0.001), lower incidence of axial symptoms (9.1% vs. 25.9%, <i>P</i> = 0.020), and lower screw loosening rate (0% vs. 6.90%, <i>P</i> = 0.047). Neurological recovery [Japanese Orthopaedic Association (JOA) score and improvement rate] and cervical range of motion (ROM) were comparable between groups at all follow-up points (<i>P</i> &gt; 0.05).</p> Conclusion <p>The “Pre-set Screw Path Technique (PSPT)” reduces operative time and blood loss, lowers the risks of axial symptoms and screw loosening, may enhance intraoperative safety by avoiding drilling adjacent to the exposed spinal cord. By shifting the critical drilling step to before spinal canal exposure, this technique simplifies the surgical workflow. Although its impact on the learning curve requires further investigation, the procedure is technically straightforward and may facilitate adoption by surgeons in training.</p>

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Clinical efficacy and safety analysis of the “Pre-set screw path technique” in cervical posterior single door laminoplasty with supportive titanium plate fixation: a prospective randomized controlled study

  • 期刊论文

  • 发表日期：

    2026年5月25日

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  • Pengcheng Mao,
  • Donghui Cao,
  • Xusheng Li,
  • Xi Zhu,
  • Xiao Zhang,
  • Wengbo Gu,
  • Yu Yang,
  • Yanrong Tian,
  • Haifeng Yuan

摘要

Objective

To evaluate the clinical efficacy and safety of a "Pre-set Screw Path Technique (PSPT)” compared with the traditional drilling method in cervical posterior open-door laminoplasty with titanium plate fixation.

Methods

In this prospective randomized controlled trial, 113 patients with multilevel cervical spondylotic myelopathy undergoing C3–C7 laminoplasty (February 2019–February 2023) were allocated to either the control group (n = 58, traditional drilling) or the experimental group (n = 55, pre-set screw path technique). The primary outcome was the incidence of intraoperative spinal cord or nerve root injury related to drilling. Secondary outcomes included operative duration, intraoperative blood loss, neurological recovery [Japanese Orthopaedic Association (JOA) score and improvement rate at 1 week, 3, 6, and 12 months], cervical range of motion (ROM), axial symptoms, and other complications (screw loosening, dural tear, C5 palsy, etc.).

Results

For the primary endpoint, no spinal cord or nerve root injury occurred in the experimental group (0/55), while one transient nerve root irritation was observed in the control group (1/58, 1.72%); the difference was not statistically significant (P = 0.328). Secondary outcomes showed that the experimental group had significantly shorter operative time (86.07 ± 21.97 vs. 106.29 ± 47.56 min, P < 0.05), reduced blood loss (111.09 ± 35.21 vs. 168.19 ± 97.35 ml, P < 0.001), lower incidence of axial symptoms (9.1% vs. 25.9%, P = 0.020), and lower screw loosening rate (0% vs. 6.90%, P = 0.047). Neurological recovery [Japanese Orthopaedic Association (JOA) score and improvement rate] and cervical range of motion (ROM) were comparable between groups at all follow-up points (P > 0.05).

Conclusion

The “Pre-set Screw Path Technique (PSPT)” reduces operative time and blood loss, lowers the risks of axial symptoms and screw loosening, may enhance intraoperative safety by avoiding drilling adjacent to the exposed spinal cord. By shifting the critical drilling step to before spinal canal exposure, this technique simplifies the surgical workflow. Although its impact on the learning curve requires further investigation, the procedure is technically straightforward and may facilitate adoption by surgeons in training.