Anatomical analysis of human ligamentum flavum in the cervical spine: Special consideration to the attachments, coverage, and lateral extent

Rahmani, Mohammad Suhrab; Terai, Hidetomi; Akhgar, Javid; Suzuki, Akinobu; Toyoda, Hiromitsu; Hoshino, Minoru; Tamai, Katsuto; Ahmadi, Sayed Abdullah; Hayashi, Kazunori; Takahashi, Shinji; Nakamura, Hiroaki

doi:10.1016/j.jos.2017.07.008

Cited by 15 publications

(9 citation statements)

References 21 publications

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“…The LF covered the interlaminar space. In the present model, it is impossible to conclude the mechanical characteristics of the partial or total resection of LF for laminoplasty [48]. Although there are several methods of laminoplasty [49], this paper only analyzes double-door laminoplasty.…”

Section: Discussionmentioning

confidence: 95%

Biomechanical Analysis of Posterior Ligaments of Cervical Spine and Laminoplasty

et al. 2021

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Cervical laminoplasty is a valuable procedure for myelopathy but it is associated with complications such as increased kyphosis. The effect of ligament damage during cervical laminoplasty on biomechanics is not well understood. We developed the C2–C7 cervical spine finite element model and simulated C3–C6 double-door laminoplasty. Three models were created (a) intact, (b) laminoplasty-pre (model assuming that the ligamentum flavum (LF) between C3–C6 was preserved during surgery), and (c) laminoplasty-res (model assuming that the LF between C3–C6 was resected during surgery). The models were subjected to physiological loading, and the range of motion (ROM), intervertebral nucleus stress, and facet contact forces were analyzed under flexion/extension, lateral bending, and axial rotation. The maximum change in ROM was observed under flexion motion. Under flexion, ROM in the laminoplasty-pre model increased by 100.2%, 111.8%, and 98.6% compared to the intact model at C3–C4, C4–C5, and C5–C6, respectively. The ROM in laminoplasty-res further increased by 105.2%, 116.8%, and 101.8% compared to the intact model at C3–C4, C4–C5, and C5–C6, respectively. The maximum stress in the annulus/nucleus was observed under left bending at the C4–C5 segment where an increase of 139.5% and 229.6% compared to the intact model was observed for laminoplasty-pre and laminoplasty-res model, respectively. The highest facet contact forces were observed at C4–C5 under axial rotation, where an increase of 500.7% and 500.7% was observed compared to the intact model for laminoplasty-pre and laminoplasty-res, respectively. The posterior ligaments of the cervical spine play a vital role in restoring/stabilizing the cervical spine. When laminoplasty is performed, the surgeon needs to be careful not to injure the posterior soft tissue, including ligaments such as LF.

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Section: Discussionmentioning

confidence: 95%

Biomechanical Analysis of Posterior Ligaments of Cervical Spine and Laminoplasty

et al. 2021

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“…Therefore, it is exposed to the risk of thermal damage during manipulation around the foramen. Takenaga et al reported lower C5 palsy in the group using chilled irrigation than in the control group in 400 cases of open door laminoplasty [ 33 , 34 ]. In all cases of this study, during manipulation around the foramen, in order to reduce the possibility of thermal injury that may occur during drilling, saline irrigation was performed.…”

Section: Discussionmentioning

confidence: 99%

Posterior Preventive Foraminotomy before Laminectomy Combined with Pedicle Screw Fixation May Decrease the Incidence of C5 Palsy in Complex Cervical Spine Surgery in Patients with Severe Myeloradiculopathy

Lee

Abdou

Kwon

et al. 2023

JCM

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C5 palsy is a frequent sequela of cervical decompression surgeries for cervical myeloradiculopathy. Although many researchers have suggested various risk factors, such as cord shifting and the correction of lordotic angles, the tethering of the C5 root beneath the narrow foramen is an independent risk factor for C5 palsy. In this study, we tried to investigate different techniques for foramen decompression with posterior cervical fusion and assess the incidence of C5 palsy with each technique depending on the order of foraminal decompression. A combined 540° approach with LMS and uncovertebrectomy was used in group 1. Group 2 combined a 540° approach with pedicle screws and posterior foraminotomy, while posterior approach only with pedicle screws and foraminotomy was used in group 3. For groups 2 and 3, prophylactic posterior foraminotomy was performed before laminectomy. Motor manual testing to assess C5 palsy, the Neck Disability Index (NDI) and the Japanese Orthopedic Association (JOA) scores were determined before and after surgery. Simple radiographs, MRI and CT scans, were obtained to assess radiologic parameters preoperatively and postoperatively. A total of 362 patients were enrolled in this study: 208 in group 1, 72 in group 2, and 82 in group 3. The mean age was 63.2, 65.5, and 66.6 years in groups 1, 2, and 3, respectively. The median for fused levels was 4 for the three groups. There was no significant difference between groups regarding the number of fused levels. Weight, height, comorbidities, and diagnosis were not significantly different between groups. Preoperative JOA scores were similar between groups (p = 0.256), whereas the preoperative NDI score was significantly higher in group 3 than in group 2 (p = 0.040). Mean JOA score at 12-month follow-up was 15.5 ± 1.89, 16.1 ± 1.48, and 16.1 ± 1.48 for groups 1, 2, and 3, respectively; it was higher in group 3 compared with group 1 (p = 0.008) and in group 2 compared with group 1 (p = 0.024). NDI score at 12 months was 13, 12, and 13 in groups 1, 2, and 3, respectively; it was significantly better in group 3 than in group 1 (p = 0.040), but there were no other significant differences between groups. The incidence of C5 palsy was significantly lower in posterior foraminotomy groups with pedicle screws (groups 2 and 3) than in LMS with uncovertebrectomy (group 1) (p < 0.001). Thus, preventive expansive foraminotomy before decompressive laminectomy is able to significantly decrease the root tethering by stenotic lesion, and subsequently, decrease the incidence of C5 palsy associated with posterior only or combined posterior and anterior cervical fusion surgeries. Additionally, such expansive foraminotomy might be appropriate with pedicle screw insertion based on biomechanical considerations.

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“…It steadily decreases from medial to lateral within each cervical vertebra. CLF in cervical spine does not enter the cervical neural foramen [10] . Both thickness and width are comparatively constant from caudal to cranial.…”

Section: Introductionmentioning

confidence: 93%

“…CLF in cervical spine does not enter the cervical neural foramen. [ 10 ] Both thickness and width are comparatively constant from caudal to cranial. The laminar surface area covered by CLF progressively increases from 33.0% in para midline at C2 level to 70.0% in para midline at C6 level.…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of cervical ligamentum flavum thickness as a morphological parameter to predict cervical stenosis

Jeong

Lee

et al. 2021

Medicine

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One of major causes of cervical central stenosis (CCS) is thickened change of cervical ligament flavum (CLF). The association of a morphological parameter called cervical ligament flavum thickness (CLFT) with CCS has not been reported yet. Thus, the purpose of this research was to investigate the relationship between CCS and CFJT. Data were obtained from 88 patients with CCS. A total of 87 normal controls also underwent cervical spine magnetic resonance imaging (CSMRI). All subjects underwent axial T2-weighted CSMRI. Using our picture archiving and communications system, thickness of ligament flavum of the cervical spine at C6/7 level was analyzed. The mean CLFT was 1.41 ± 0.24 mm in normal subjects and 2.09 ± 0.39 mm in patients with CCS. The CCS group was found to have significantly ( P < .001) higher rate of CLFT than normal subjects. ROC curves were used to assess the usefulness of CLFT as a predictor of CCS. In the CCS group, the best practical cut off-point of CLFT was 1.71 mm (sensitivity = 90.9%; specificity = 90.8%), with AUC of 0.94 (95% confidence interval: 0.90--0.98). Greater CLFT values were associated with greater possibility of CCS. Thus, treating physician should carefully examine CLFT, as it can help diagnose CCS.

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Anatomical analysis of human ligamentum flavum in the cervical spine: Special consideration to the attachments, coverage, and lateral extent

Cited by 15 publications

References 21 publications

Biomechanical Analysis of Posterior Ligaments of Cervical Spine and Laminoplasty

Biomechanical Analysis of Posterior Ligaments of Cervical Spine and Laminoplasty

Posterior Preventive Foraminotomy before Laminectomy Combined with Pedicle Screw Fixation May Decrease the Incidence of C5 Palsy in Complex Cervical Spine Surgery in Patients with Severe Myeloradiculopathy

Prognostic value of cervical ligamentum flavum thickness as a morphological parameter to predict cervical stenosis

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