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

Tai, Ching‐Lung; Hsieh, Pang-Hsing; Chen, Weng-Pin; Chen, Lih-Huei; Chen, Wen-Jer; Lai, Po‐Liang

doi:10.1186/1471-2474-9-84

Cited by 92 publications

(89 citation statements)

References 29 publications

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“…We suggest that this may help prevent spinal instability, which can occur after traditional laminectomy [9]. Indeed, Tai et al [17] have suggested that maintained integrity of the posterior complex helps stabilize the decompressed spine. In addition to preserving the facet joint and supraspinal ligament, PLF or PLIF with or without instrumentation was performed for patients with degenerative spondylolisthesis, adult lumbar scoliosis, or multilevel stenosis.…”

Section: Discussionmentioning

confidence: 99%

“…Laminectomy is the standard option for surgical decompression of spinal stenosis. However, traditional laminectomy involves extensive removal of the posterior elements including the lamina, spinous processes, superspinous ligaments, interspinous ligaments, and even facet joints, which may result in iatrogenic spinal instability [16,17]. Foraminotomy has become increasingly popular for treatment of patients with lumbar stenosis.…”

Section: Introductionmentioning

confidence: 99%

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Clinical outcomes following sublaminar-trimming laminoplasty for extensive lumbar canal stenosis

et al. 2013

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Purpose Current surgical approaches for treatment of lumbar canal stenosis are often associated with relatively high rates of reoperation and recurrent stenosis. We have developed a new approach for treatment of this condition: sublaminar-trimming laminoplasty. To describe the surgical approach of sublaminar-trimming laminoplasty and to assess associated outcomes. Methods Patients with extensive lumbar canal stenosis who received sublaminar-trimming laminoplasty from 2006 to 2008 were considered for inclusion in the study. The surgery comprised aspects of laminotomy and laminectomy. The following were assessed before surgery and 3 years after surgery: leg and back pain by visual analog scale (VAS), extent of disability by Oswestry Disability Index (ODI), severity of back pain by Japanese Orthopedic Association Score for Back Pain (JOA), walking tolerance, and leg numbness. Complications were noted. Results A total of 49 patients were included in the study (mean age 65.6 ± 10.6 years). VAS leg and back pain, ODI, and JOA scores significantly changed from before surgery to 3 years after surgery (P \ 0.001). Mean changes (95 % confidence interval) were -6.2

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical outcomes following sublaminar-trimming laminoplasty for extensive lumbar canal stenosis

et al. 2013

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“…[3,6,8,9,12,16,17] Although recent biomechanical studies have shown that a number of spinal devices can be used for rigid fixation and fusion at the treated level, little attention has been focused on the adjacent segment instability. [2,5,6,8,12,13,[16][17][18] The present study focused on the adjacent segment instability. As adjacent segment mobility increased, the anterior and posterior structures maintained stability and prevented instability.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4] The posterior structures of the facet joints are particularly important stabilizers of the motion segment. The orientation of the facets in the lumbar spine facilitates flexion and extension and aids in resisting torsion and shear load.…”

Section: Methodsmentioning

confidence: 99%

“…[6] Following arthrodesis at L4-L5, the most common level of fusion, adjacent disc disease additional surgery is required in approximately 15% of patients. [2,3,12] Progression of the free mobile segment next to the spinal fusion is referred to as adjacent segment disease including disc degeneration, facet joint hypertrophy, spinal stenosis, and even acquired spondylolisthesis. [9] The etiology of adjacent segment degeneration is not fully known, however, two theories have been proposed thus far.…”

Section: Methodsmentioning

confidence: 99%

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Rigid fixation of the lumbar spine alters the motion and mechanical stability at the adjacent segment level

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et al. 2014

Eklem Hastalik Cerrahisi

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Amaç: Bu çalışmada lomber omurganın rijit tespitinden sonra komşu segmentin hareket genişliği ve stabilitesi araş-tırıldı. Gereç ve yöntemler: Bu çalışmada 17 taze donmuş kuzu lomber omurgası (sakrum T 12 'yi içeren) kullanıl-dı. Biyomekanik test aksiyel kompresyon test cihazı ile yapıldı. Aksiyel kompresyon tüm numunelere 5 mm/dk. yükleme hızı ile uygulandı. Özel dizayn edilmiş fikstür ile 8400 Nmm tork oluşturuldu. Fikstür aksiyel yönde fleksiyon, ekstansiyon, sağ ve sola eğilme pozisyonlarında yüklenme uygulanacak şekilde numuneler ayarlandı. Tüm numuneler sağlam omurga, pedikül vida ve rod fiksasyonu sonrasında teste tabi tutuldu. Test esnasında komşu seviye L5-S1 arasındaki ayrılma değerleri süreğen bir şekilde ekstansometre ile kaydedildi. Bulgular: Komşu segmentte (L5-S1), aksiyel yüklenme ve üst-alt ayrılma değerleri, ön-arka ayrılma değerlerinden düşük bulundu. İstatistiksel analizde sağlam omurga ile komşu segment arasında aksiyel kompresyon ve ekstansiyon pozisyonunda sayısal anlamlı değişiklikler tespit edildi (p<0.027). Bunun yanında ekstansiyon pozisyonunda komşu segmentte sağlam omurgaya göre daha yüksek çıktı (p<0.015). Sonuç: Lomber omurganın rijit fiksasyonu komşu segment seviyesinde hareket genişliğini değiştirmektedir. Bundan dolayı, komşu segmentte anormal stres ve spinal instabiliteye neden olur; bu durum, faset eklem dejenerasyonuna ve bel ağrılarına yol açabilir.Anahtar sözcükler: Komşu segment instabilitesi; faset eklem; omurlar arası disk; lomber omurga.Objectives: This study aims to examine the motion and stability of the adjacent segment following rigid fixation of the lumbar spine. Materials and methods:The study included 17 fresh-frozen lamb lumbar spines (including the sacrum to T 12 ). Biomechanical testing was performed using an axial compression testing machine. Axial compression was applied to all the specimens using a loading speed of 5 mm min-1. A specifically designed fixture was used to generate torque ≤8400 Nmm. The fixture was used with each specimen to achieve flexion and extension, axial neutral compression, and right and left bending. All specimens were tested intact, and again after implantation using posterior pedicle screws and rod fixation. During testing intervertebral displacement at the adjacent level (L5-S1) was recorded continuously via extensometry. Results: Axial compression and superior-inferior displacement were lower in the adjacent segment (L5-S1) than anterior-posterior displacement following rigid fixation. Statistical analysis showed that there was a numerical difference and a significant change between the intact spine and the adjacent segment in the axial compression and extension positions (p<0.027). The intact spines demonstrated the maximum displacement and the difference in extension positions were significant (p<0.015). Conclusion: Rigid fixation of the lumbar spine altered the range of motion at the adjacent segment level. As such, abnormal stress on the adjacent segment causes spinal instability, which may subsequently cause facet joint degen...

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Effectiveness of posterior decompression techniques compared to conventional laminectomy for lumbar stenosis

Overdevest¹,

Jacobs²,

Vleggeert-Lankamp³

et al. 2012

Cochrane Database of Systematic Reviews

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Purpose To compare the effectiveness of techniques of posterior decompression that limit the extent of bony decompression or to avoid removal of posterior midline structures of the lumbar spine versus conventional facetpreserving laminectomy for the treatment of patients with degenerative lumbar stenosis. Methods A comprehensive electronic search of the Cochrane Central Register of Controlled Trials, MED-LINE, EMBASE, Web of Science, and the clinical trials registries ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform was conducted for relevant literature up to June 2014.Results A total of four high-quality RCTs and six lowquality RCTs met the search criteria of this review. These studies included a total of 733 participants. Three different techniques that avoid removal of posterior midline structures are compared to conventional laminectomy; unilateral laminotomy for bilateral decompression, bilateral

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

Cited by 92 publications

References 29 publications

Clinical outcomes following sublaminar-trimming laminoplasty for extensive lumbar canal stenosis

Clinical outcomes following sublaminar-trimming laminoplasty for extensive lumbar canal stenosis

Rigid fixation of the lumbar spine alters the motion and mechanical stability at the adjacent segment level

Effectiveness of posterior decompression techniques compared to conventional laminectomy for lumbar stenosis

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