Biomechanical comparison of lumbar spine instability between laminectomy and bilateral laminotomy for spinal stenosis syndrome -an experimental study in porcine model

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• 作者：Ching-Lung Tai (1) (2)
  Pang-Hsing Hsieh (2)
  Weng-Pin Chen (3)
  Lih-Huei Chen (2)
  Wen-Jer Chen (2)
  Po-Liang Lai (2)
  
• 刊名：BMC Musculoskeletal Disorders
• 出版年：2008
• 出版时间：December 2008
• 年：2008
• 卷：9
• 期：1
• 全文大小：1397KB
• 参考文献：1. Hopp E, Tsou PM: Postdecompression lumbar instability. / Clin Orthop 1988, 227:143-51.
  2. Johnsson KE, Willner S, Johnsson K: Postoperative instability after decompression for lumbar spinal stenosis. / Spine 1986,11(2):107-10. CrossRef
  3. Katz JN, Lipson SJ, Larson MG: The outcome of decompressive laminectomy for degenerative lumbar stenosis. / J Bone Joint Surg Am 1991,73(6):809-16.
  4. Lu WW, Luk KD, Ruan DK, Fei ZQ, Leong JC: Stability of the whole lumbar spine after multilevel fenestration and discectomy. / Spine 1999,24(13):1277-282. CrossRef
  5. Herron LD, Pheasant HC: Bilateral laminotomy and discectomy for segmental lumbar disk disease. Decompression with stability. / Spine 1983,8(1):86-7. CrossRef
  6. Lee TT, Manzano GR, Green BA: Modified open-door cervical expansive laminoplasty for spondylotic myelopathy: Operative technique, outcome, and predictors for gait improvement. / J Neurosurg 1997,86(1):64-8. CrossRef
  7. Weiner BK, Walker M, Brower RS, McCulloch JA: Microdecompression for lumbar spinal canal stenosis. / Spine 1999,24(21):2268-281. CrossRef
  8. Sharma M, Langrana NA, Rodriguez J: Role of ligaments and facets in lumbar spinal stability. / Spine 1995,20(8):887-00. CrossRef
  9. Fox MW, Onofrio BM, Hanssen AD: Clinical outcomes and radiological instability following decompressive lumbar laminectomy for degenerative spinal stenosis: A comparison of patients undergoing concomitant arthrodesis versus decompression alone. / J Neurosurg 1996,85(5):793-02. CrossRef
  10. Grob D, Humke T, Dvorak J: Degenerative lumbar spinal stenosis: Decompression with and without arthrodesis. / J Bone Joint Surg Am 1995,77(7):1036-041.
  11. Mayer RS, Chen IH, Lavender SA, Trafimow JH, Andersson GB: Variance in the measurement of sagittal lumbar spine range of motion among examiners, subjects, and instruments. / Spine 1995,20(13):1489-493. CrossRef
  12. Postacchini F, Cinotti G, Perugia D, Gumina S: The surgical treatment of central lumber stenosis. Multiple laminotomy compared with total laminectomy. / J Bone Joint Surg Br 1993,75(3):386-92.
  13. Ensink FB, Saur PM, Frese K, Seeger D, Hildebrandt J: Lumbar range of motion: influence of time of day and individual factors on measurements. / Spine 1996,21(11):1339-343. CrossRef
  14. Goel VK, Fromknecht SJ, Nishiyama K, Weinstein J, Liu YK: The role of the lumbar spinal elements in flexion. / Spine 1985,10(6):516-23. CrossRef
  15. Goel VK, Goyal S, Clark C, Nishiyama K, Nye T: Kinematics of the whole lumbar spine: Effect of discectomy. / Spine 1985,10(6):543-54. CrossRef
  16. Kanayama M, Abumi K, Kaneda K, Tadano S, Ukai T: Phase lag of the intersegmental motion in flexion-extension of the lumbar and lumbosacral spine: an in vivo study. / Spine 1996,21(12):1416-422. CrossRef
  17. Mayer TG, Vanharanta H, Gatchel RJ, Mooney V, Barnes D, Judge L, Smith S, Terry A: Comparison of CT scan muscle measurements and isokinetic trunk strength in postoperative patients. / Spine 1989,14(1):33-6. CrossRef
  18. Gurr KR, McAfee PC, Shih CM: Biomechanical analysis of anterior and posterior instrumentation systems after corpectomy. / J Bone Joint Surg Am 1988,70(8):1182-191.
  19. Shono Y, Kaneda K, Abumi K, McAfee PC, Cunningham BW: Stability of posterior spinal instrumentation and its effects on adjacent motion segments in the lumbosacral spine. / Spine 1998,23(14):1550-558. CrossRef
  20. Chen WJ, Lai PL, Tai CL, Chen LH, Niu CC: The Effect of sagittal alignment on adjacent joint mobility after lumbar instrumentation -a biomechanical study of lumbar vertebrae in a porcine model. / Clin Biomech 2004,19(8):763-68. CrossRef
  21. Chen LH, Lai PL, Tai CL, Niu CC, Fu TS, Chen WJ: The effect of interspinous ligament integrity on adjacent segment instability after lumbar instrumentation and laminectomy -an experimental study in porcine model. / Biomed Mater Eng 2006,16(4):261-67.
  22. Smit TH: The use of a quadruped as an in vivo model for the study of the spine -biomechanical considerations. / Eur Spine J 2002,11(2):137-44. CrossRef
  23. Asazuma T, Stokes IAF, Moreland MS, Suzuki N: Intersegmental spinal flexibility with lumbosacral instrumentation -an in vitro biomechanical investigation. / Spine 1990,15(11):1153-158. CrossRef
  24. Gillespie KA, Dickey JP: Biomechanical role of lumbar spine ligaments in flexion and extension: determination using a parallel linkage robot and a porcine model. / Spine 2004,29(11):1208-216. CrossRef
  25. Gurwitz GS, Dawson JM, McNamara MJ, Federspiel CF, Spengler DM: Biomechanical analysis of three surgical approaches for lumbar burst fractures using short-segment instrumentation. / Spine 1993,18(8):977-82. CrossRef
  26. Kaigle A, Ekstrom L, Holm S, Rostedt M, Hansson T: In vivo dynamic stiffness of the porcine lumbar spine exposed to cyclic loading: influence of load and degeneration. / J Spinal Disord 1998,11(1):65-0. CrossRef
  27. Kostuik JP, Munting E, Valdevit A: Biomechanical analysis of screw load sharing in pedicle fixation of the lumbar spine. / J Spinal Disord 1994,7(5):394-01. CrossRef
  28. Russell GR, Lavoie G, Evenson R, Moreau M, Budney D, Raso VJ: A reproducible porcine vertebral fracture for biomechanical testing of spinal fixation devices. / Clin Orthop 1992, 284:267-72.
  29. Smith MEH, Bebchuk TN, Shmon CL, Watson LG, Steinmetz H: An in vitro biomechanical study of the effects of surgical modification upon the canine lumbosacral spine. / Vet Comp Orthop Traumatol 2004,17(1):17-4.
  30. Kostuik JP, Smith TJ: Pitfalls of biomechanical testing. / Spine 1991,16(10):1233-. CrossRef
  31. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2474/9/84/prepub
  
• 作者单位：Ching-Lung Tai (1) (2)
  Pang-Hsing Hsieh (2)
  Weng-Pin Chen (3)
  Lih-Huei Chen (2)
  Wen-Jer Chen (2)
  Po-Liang Lai (2)
  
  1. Graduate Institute of Medical Mechatronics, Department of Mechanical Engineering, Chang Gung University, Taoyuan, Taiwan
  2. Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
  3. Department of Biomedical Engineering, Chung Yuan Christian University, Chungli, 32023, Taiwan
  

文摘

Background The association of lumbar spine instability between laminectomy and laminotomy has been clinically studied, but the corresponding in vitro biomechanical studies have not been reported. We investigated the hypothesis that the integrity of the posterior complex (spinous process-interspinous ligament-spinous process) plays an important role on the postoperative spinal stability in decompressive surgery. Methods Eight porcine lumbar spine specimens were studied. Each specimen was tested intact and after two decompression procedures. All posterior components were preserved in Group A (Intact). In Group B (Bilateral laminotomy), the inferior margin of L4 lamina and superior margin of L5 lamina were removed, but the L4–L5 supraspinous ligament was preserved. Fenestrations were made on both sides. In Group C (Laminectomy) the lamina and spinous processes of lower L4 and upper L5 were removed. Ligamentum flavum and supraspinous ligament of L4–L5 were removed. A hydraulic testing machine was used to generate an increasing moment up to 8400 N-mm in flexion and extension. Intervertebral displacement at decompressive level L4–L5 was measured by extensometer Results The results indicated that, under extension motion, intervertebral displacement between the specimen in intact form and at two different decompression levels did not significantly differ (P > 0.05). However, under flexion motion, intervertebral displacement of the laminectomy specimens at decompression level L4–L5 was statistically greater than in intact or bilateral laminotomy specimens (P = 0.0000963 and P = 0.000418, respectively). No difference was found between intact and bilateral laminotomy groups. (P > 0.05). Conclusion We concluded that a lumbar spine with posterior complex integrity is less likely to develop segment instability than a lumbar spine with a destroyed anchoring point for supraspinous ligament.