The Anatomical and Biomechanical Superiority of Novel Posterior En Bloc Elevation Cervical Laminoplasty

Abstract

Objectives. In this study, we performed a novel type of posterior en bloc elevation cervical laminoplasty (PEEL) to keep the integrity of the posterior structure, aiming to reduce axial symptoms complicated by a conventional cervical laminoplasty procedure. Methods. Twelve human cervical cadaveric spines (C2-T1) were sequentially tested in the following order: intact condition, open-door laminoplasty (ODL) through bilateral intermuscular approach (mini-invasive ODL), PEEL, and laminectomy (LN). After bilateral transecting at the junction of lamina and lateral mass through the tubular retraction system, the PEEL procedure symmetrically elevated all the posterior structure which was further stabilized with bone grafts and titanium plates. Computed tomography (CT) scan and biomechanical testing were performed after each condition. Results. Both mini-invasive ODL and PEEL procedures were accomplished with 2 small incisions on each side. Two types of laminoplasties could enlarge the spinal canal significantly both in cross-sectional area and anteroposterior diameter comparing with intact condition. The PEEL procedure demonstrated a significantly higher enlargement rate on a canal area and a symmetrical expansion pattern. Compared with intact condition, mini-invasive ODL performed from C3-C7 demonstrated significantly decreased motion in all testing directions except the flexion range of motion (ROM); the PEEL procedure showed mild and insignificant decrease on ROM in all directions. Laminectomy resulted in a statistically significant increase in all directions except the lateral bending ROM. Conclusions. Posterior en bloc elevation cervical laminoplasty can enlarge the canal more effectively and preserve better ROM after operation than the ODL procedure. Although technically challenging, the PEEL procedure probably would decrease the common complications associated with ODL laminoplasty.

Laminoplasty versus Laminectomy in the Treatment of Primary Spinal Cord Tumors in Adult Patients: A Systematic Review and Meta-analysis of Observational Studies

“…Subramaniam et al [ 41 ] noted, using cadavers, the advantage of LP over LE in maintaining spinal stability: ROM after LE was 13% greater than after LP. Despite ample evidence from biomechanical studies [ 42 ], including those using computer modeling and finite element analysis [ 43 ], the results of the clinical use of LP in PSCT surgery remain uncertain. This may be because of the wide variety of LP techniques in PSCT surgery, which is supported by the data from published studies included in our systematic review.…”

Posterior Central Laminectomy for Bilateral Decompression under a Unilateral Biportal Endoscopic approach for Multi-segmental Cervical Stenosis: Anatomic and Technical note

“…The biomechanical effects of cervical laminectomy and/or foraminotomy have always been of interest. However, it has been argued that previous cadaveric studies may not represent the biomechanics of found in clinical practice as they mostly utilized cervical specimens denuded of posterior musculature [22]. Xie et al [23] reported that when the posterior ligament complex is intact, the removal of even 50% of the facet joints does not lead to signi cant changes in cervical spine stability and mobility.…”

Surgical Treatment of Cervical Spondylotic Myelopathy

“…Moreover, Franch door laminoplasty (also known as double-door expansive laminoplasty) is another modified procedure of laminoplasty, which can achieve symmetric decompression by separating the bilateral laminae from the midline of the spinous process and lift the laminae from the spinal cord. Additionally, to minimize the intraoperative attached ligament cut-off and extensor muscle detachment and following axial pain and malalignment of the cervical spine, many modified laminoplasty procedures have been developed, such as skip laminoplasty [89], en bloc elevation cervical laminoplasty [90], and the posterior muscle-ligament complex preserving modified unilateral laminoplasty [91]. These modified procedures are designed to preserve the deep extensor attachment, preserve the spinous process attachment of C2 and/or C7, or skip the level to minimize surgical injury.…”