• Xiuru Zhang, Yongfei Zhang, Desheng Duan, and Huiqi Xie.
• Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China; Laboratory of Stem Cell and Tissue Engineering, West China Hospital, Sichuan University, Sichuan, People's Republic of China.
• World Neurosurg. 2018 Oct 1; 118: e758-e765.

ObjectiveTo evaluate the effects of preoperative simulation based on patient-specific vertebral models, and computer-assisted designed drill navigation templates in expansive open-door laminoplasty (EOLP).MethodsWe retrospectively analyzed 18 consecutive patients who underwent EOLP, 11 patients (45 vertebrae) were treated with traditional EOLP (traditional group) and 7 patients (28 vertebrae) were treated with EOLP aided by the drill navigation template and preoperative simulation (template group). We assessed the operation time, intraoperative blood loss, hospitalization expenses, visual analog scale (VAS), Japanese orthopedic association (JOA), neck disability index (NDI), Pavlov's ratio, laminoplasty opening size (LOS), hinge fracture rate and trough positions.ResultsThe operation time of template group (98.6 ± 13.0 minutes) was significantly shorter (P < 0.05) than that of traditional group (125.4 ± 13.2 minutes). Both groups achieved similar hospitalization expenses and significant improvement in VAS, JOA score, NDI, and Pavlov ratio. The postoperative hinge fracture rate of template group (0%; 0/28) was significantly lower (P < 0.05) than that of traditional group (11.1%, 5/45). In template group, all the troughs (56/56 [100%]; 28/28 on the hinge side and 28/28 on the open side), while in traditional group, only 72.2% (65/90; 31/45 on the hinge side and 34/45 on the hinge side) of the troughs were at the proper hinge position.ConclusionsDrill navigation template and preoperative simulations in EOLP are technically feasible. With the help of templates and preoperative simulation, shorten operation time, accurate trough positioning, decrease incidence of hinge fracture and could be acquired. This technique should be further studied and affirmed in clinical applications.Copyright © 2018 Elsevier Inc. All rights reserved.

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