Effect of Multilevel Open-Door Laminoplasty and Laminectomy on Flexibility of the Cervical Spine

Kode, Swathi; Gandhi, Anup; Fredericks, Douglas C.; Grosland, Nicole M.; Smucker, Joseph D.

doi:10.1097/brs.0b013e31825e6251

Cited by 21 publications

(16 citation statements)

References 27 publications

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“…Previous biomechanical studies have compared laminoplasty to laminectomy with regard to their effects on cervical ROM. 12,18,19,24 These models consistently show that laminoplasty is significantly more stable than laminectomy in FE;…”

Section: Discussionmentioning

confidence: 90%

“…Historically, many authors describe a laminoplasty performed with resection of the spinous processes to prevent "crowding" in extension, to provide room for bone graft spacers, and to prevent a loss in cervical ROM. 12,19,20,24 Conversely, others describe the importance of maintaining this dorsal tension band, 28 and a recent clinical trial showed that retention of these dorsal elements may prevent loss of sagittal alignment at 1-year follow-up.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Biomechanics of open-door laminoplasty with and without preservation of posterior structures

Healy¹,

Lubelski

West

et al. 2016

Journal of Neurosurgery: Spine

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laboratory iNveStigatioNC erviCal open-door laminoplasty (ODL) decompresses the spinal canal while maintaining nearphysiological cervical range of motion (ROM). In contrast to a standard laminectomy, which leads to postlaminectomy kyphosis in 15%-43% of cases, ODL is purported to reduce this adverse outcome. 2,3,5,16,28 Despite these advantages, reports have shown that ODL may lead to persistent neck and shoulder pain, progressive loss of ROM, and progressive cervical kyphosis. [6][7][8]11,29 There are various approaches used to perform cervical laminoplasty, many of which involve spinous process resection and disruption of intervening interspinales musculature and supraspinous ligaments (intraspinous and supraspinous ligaments [ISLs]). 5,9,20 Alternative methods have been reported that retain the dorsal ligamentous complex, and small cohorts have shown it may protect from loss of sagittal balance, while not statistically reducing cervical ROM. obJective Cervical open-door laminoplasty (ODL) is designed to decompress the spinal cord, maintain motion, and prevent postlaminectomy kyphosis. Many traditional laminoplasty techniques involve disruption of the posterior ligamentous structures, most notably the C7-T1 supraspinous ligament and interspinales muscle complex (intraspinous and supraspinous ligaments [ISLs]). methodS Eight human cervical cadaveric specimens (C2-T1) were used to investigate the subaxial kinematics following ODL with varying degrees of posterior element disruption. Ligamentous integrity was preserved and specimens were tested utilizing force control in flexion-extension (FE), lateral bending (LB), and axial rotation (AR) in the native state, and following 1) C3-7 ODL, 2) ODL with terminal ISL resection, 3) ODL with C3-7 spinous process resection, and 4) C3-7 laminectomy. Range of motion (ROM) was measured across C2-T1, "global," and at the segmental level. reSultS Compared with ODL, sectioning the terminal ISLs resulted in global ROM increases by 7.9% in FE, 2.4% in LB, and 5.6% in AR (p > 0.05), whereas laminectomy increased global ROM by 36.0% in FE (p = 0.002) and a 26.3% increase in AR ROM (p = 0.01). When considering segmental ROM, resection of the terminal ISLs increased ROM in FE by 36.5% at C2-3 (p = 0.019) and 25.4% at C7-T1 (p > 0.05). Segmental increases following C3-7 spinous process resection averaged less than 3% per level, compared with up to 40% increases in ROM per level after laminectomy. coNcluSioNS Laminectomy resulted in the greatest increase in global cervical ROM. Resection of the ISLs at C2-3 and C7-T1 increased segmental ROM at these specific levels to a similar extent that laminectomy increased ROM at each cervical level. This segmental ROM may contribute to pain or postprocedural deformity and highlights the importance of the ISLs at the terminal ends of the ODL.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Biomechanics of open-door laminoplasty with and without preservation of posterior structures

Healy¹,

Lubelski

West

et al. 2016

Journal of Neurosurgery: Spine

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“…In addition, data that we are reporting for the laminectomy and INT groups agree with the afore-mentioned studies. Laminectomy can significantly increase the instability of cervical spine after surgery [20], [21], [22].…”

Section: Discussionmentioning

confidence: 99%

Results of Cervical Recapping Laminoplasty: Gross Anatomical Changes, Biomechanical Evaluation at Different Time Points and Degrees of Level Involvement

Wang

Tao

et al. 2014

PLoS ONE

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BackgroundRecapping laminoplasty has become the frequently-used approach to the spinal canal when bone decompression of the vertebral canal is not the goal. However, what changes will occur after surgery, and whether recapping laminoplasty can actually reduce the risk of delayed deformities remains unknown.MethodologyWe designed an animal experiment using a caprine model, and partitioned the animals into in vitro and in vivo surgical groups. We performed recapping laminoplasty on one group and laminectomy on another group. These animals were sacrificed six months after operating, cervical spines removed, biomechanically tested, and these data were compared to determine whether the recapping laminoplasty technique leads to subsequent differences in range of motion. Image data were also obtained before the surgery and when the animals were killed. Besides, we investigated the initial differences in kinetics between recapping laminoplasty and laminectomy. We did this by comparing data obtained from biomechanical testing of in vitro-performed recapping laminoplasty and laminectomy. Finally, we investigated the effect that longitudinal distance has on cervical mechanics. This was determined by performing a two-level recapping laminoplasty, and then extending the laminoplasty to the next level and repeating the mechanical testing at each step.Principal FindingsThere were three mainly morphological changes at the six months after laminoplasty: volume reduction and bone nonunion of the recapping laminae, irregular fibrosis formation around the facet joints and re-implanted lamina-ligamentous complex. In the biomechanical test, comparing with laminectomy, recapping laminoplasty didn’t show significant differences in the immediate postoperative comparison, while recapping laminoplasty demonstrated significantly decreased motion in flexion/extension six months later. Inclusion of additional levels in the laminotomy procedure didn’t lead to changes in immediate biomechanics.ConclusionsRecapping laminoplasty can’t fully restore the posterior structure, but still reduced the risk of delayed cervical instability in a caprine model.

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“…The effect of multilevel open door laminoplasty and laminectomy on the flexibility of the cervical spine has been studied in a cadaveric study by Kode et al 13 They found that laminectomy caused a significant motion increase in the C2-T1 segment because of the loss of the posterior structures. Laminoplasty showed opposite results, with a 17 to 20% decrease in the postoperative motion of the same segment.…”

Section: Does Laminoplasty Preserve Motion?mentioning

confidence: 99%

Laminoplasty for Cervical Spondylotic Myelopathy

Fransen¹

2014

The Journal of Spinal Surgery

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Cervical spondylotic myelopathy (CSM) is a commonly treated either by uninstrumented laminectomy, carrying the risk of postoperative instability, or by anterior or posterior decompression with fusion resulting in postoperative stiffness and possibly adjacent segment degeneration.Cervical laminoplasty, initially developed for pediatric or OPLL patients could be an interesting surgical alternative to decompress and reconstruct cervical anatomy without fusion.Sixteen patients, mean age 63, who presented with CSM were treated surgically using multilevel laminoplasty, and reviewed after 1 month, 6 months, 1 and 2 years. Clinical evaluation was performed based on the Benzel-JOA and Nurick scores. The preoperative mean Benzel-JOA score was 13.43; preoperative mean Nurick score was 1.81. Intramedullary hyperintensity in T2 MRI was observed in five patients. The operation was performed on 2 levels (19%) 3 levels (69%) and 4 levels (12%).We used the open-door hinged laminoplasty technique, using metallic implants, without bone graft. At one month FU, mean JOA score was 15.44, and Nurick dropped to 1.05. At 6 months, mean JOA was 16.36 and Nurick was 0.72. At one year, the mean JOA score was 16.16, and Nurick was 0.83. At 2 years, mean JOA was 17.5 and Nurick was 0.25.We reviewed the possible advantages and complications of spinal cord decompression by open-door laminoplasty for CSM. We conclude that this technique allows significant clinical improvement observed progressively in the two years following surgery without increased rigidity or instability.

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Effect of Multilevel Open-Door Laminoplasty and Laminectomy on Flexibility of the Cervical Spine

Abstract: Both 2-level and multilevel laminoplasty preserved the C2-T1 range of motion. Laminectomy resulted in a significant increase in C2-T1 motion due to the loss of the posterior structures.

Cited by 21 publications

References 27 publications

Biomechanics of open-door laminoplasty with and without preservation of posterior structures

Biomechanics of open-door laminoplasty with and without preservation of posterior structures

Results of Cervical Recapping Laminoplasty: Gross Anatomical Changes, Biomechanical Evaluation at Different Time Points and Degrees of Level Involvement

Laminoplasty for Cervical Spondylotic Myelopathy

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