Which factors prognosticate spinal instability following lumbar laminectomy?

Bisschop, Arno; Royen, Barend J. van; Mullender, Margriet G.; Paul, Cornelis P. L.; Kingma, Idsart; Jiya, Timothy U.; Veen, Albert J. van der; Dieën, Jaap H. van

doi:10.1007/s00586-012-2250-y

Cited by 28 publications

(28 citation statements)

References 26 publications

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“…Therefore, TMF and shear force to failure represent different clinical value. For shear biomechanical prediction, DXA parameters, including BMD, BMC and segmental frontal area, were found to be of utmost importance [4]. However, in the present study, only BMC and segmental frontal area were found to be important in the prediction of torsion stiffness parameters after laminectomy.…”

Section: Discussioncontrasting

confidence: 62%

“…This yield phase reflects a decrease in stiffness, which possibly indicates the first damage to the structure [23]. Since the yield phase in the load-displacement curves did not show a smooth continuous curve between ETS and LTS, we could not define a specific yield point as was defined previously for shear loading [4]. We expect that when a spinal segment reaches its LTS zone, sub-clinical damage will have occurred.…”

Section: Discussionmentioning

confidence: 99%

“…Shear biomechanical properties after laminectomy could be predicted from imaging data, which may support such decision-making [4]. However, in daily practice the spine is also loaded in torsion [3].…”

Section: Introductionmentioning

confidence: 99%

“…Previously, it has been shown in an in vitro experiment that laminectomy results in a substantial decrease of torsion stiffness and torsion moment to failure (TMF) of lumbar spinal segments [3]. For shear loads, the biomechanical behaviour of a spinal motion segment following laminectomy has been shown to depend on disc degeneration, facet joint degeneration, Modic changes, Schmorl's nodes, intervertebral disc and pedicle geometry, and facet joint angles [4]. This may also hold for torsion strength and stiffness following laminectomy.…”

Section: Introductionmentioning

confidence: 99%

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Which factors prognosticate rotational instability following lumbar laminectomy?

Bisschop

Kingma²,

Bleys³

et al. 2013

Eur Spine J

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Purpose Reduced strength and stiffness of lumbar spinal motion segments following laminectomy may lead to instability. Factors that predict shear biomechanical properties of the lumbar spine were previously published. The purpose of the present study was to predict spinal torsion biomechanical properties with and without laminectomy from a total of 21 imaging parameters. Method Radiographs and MRI of ten human cadaveric lumbar spines (mean age 75.5, range 59-88 years) were obtained to quantify geometry and degeneration of the motion segments. Additionally, dual X-ray absorptiometry (DXA) scans were performed to measure bone mineral content and density. Facet-sparing lumbar laminectomy was performed either on L2 or L4. Spinal motion segments were dissected (L2-L3 and L4-L5) and tested in torsion, under 1,600 N axial compression. Torsion moment to failure (TMF), early torsion stiffness (ETS, at 20-40 % TMF) and late torsion stiffness (LTS, at 60-80 % TMF) were determined and bivariate correlations with all parameters were established. For dichotomized parameters, independent-sample t tests were used. Results Univariate analyses showed that a range of geometric characteristics and disc and bone quality parameters were associated with torsion biomechanical properties of lumbar segments. Multivariate models showed that ETS, LTS and TMF could be predicted for segments without laminectomy (r 2 values 0.693, 0.610 and 0.452, respectively) and with laminectomy (r 2 values 0.952, 0.871 and 0.932, respectively), with DXA-derived measures of bone quality and quantity as the main predictors. Conclusions Vertebral bone content and geometry, i.e. intervertebral disc width, frontal area and facet joint tropism, were found to be strong predictors of ETS, LTS and TMF following laminectomy, suggesting that these variables could predict the possible development of postoperative rotational instability following lumbar laminectomy. Proposed diagnostic parameters might aid surgical decision-making when deciding upon the use of instrumentation techniques.

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Section: Discussioncontrasting

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Which factors prognosticate rotational instability following lumbar laminectomy?

Bisschop

Kingma²,

Bleys³

et al. 2013

Eur Spine J

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“…The effect of lumbar laminectomy on intervertebral shear stiffness and shear force to failure is well-known [5,6]. However, during daily activities such as asymmetric lifting [17], the lumbar spine is not only subjected to shear forces but also to torsion moments and the resulting axial rotation.…”

Section: Introductionmentioning

confidence: 99%

Torsion biomechanics of the spine following lumbar laminectomy: a human cadaver study

et al. 2013

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Purpose Lumbar laminectomy affects spinal stability in shear loading. However, the effects of laminectomy on torsion biomechanics are unknown. The purpose of this study was to investigate the effect of laminectomy on torsion stiffness and torsion strength of lumbar spinal segments following laminectomy and whether these biomechanical parameters are affected by disc degeneration and bone mineral density (BMD). Methods Ten human cadaveric lumbar spines were obtained (age 75.5, range 59-88). Disc degeneration (MRI) and BMD (DXA) were assessed. Disc degeneration was classified according to Pfirrmann and dichotomized in mild or severe. BMD was defined as high BMD (Cmedian BMD) or low BMD (\median BMD). Laminectomy was performed either on L2 (59) or L4 (59). Twenty motion segments (L2-L3 and L4-L5) were isolated. The effects of laminectomy, disc degeneration and BMD on torsion stiffness (TS) and torsion moments to failure (TMF) were studied.Results Load-displacement curves showed a typical bi-phasic pattern with an early torsion stiffness (ETS), late torsion stiffness (LTS) and a TMF. Following laminectomy, ETS decreased 34.1 % (p \ 0.001), LTS decreased 30.1 % (p = 0.027) and TMF decreased 17.6 % (p = 0.041). Disc degeneration (p \ 0.001) and its interaction with laminectomy (p \ 0.031) did significantly affect ETS. In the mildly degenerated group, ETS decreased 19.7 % from 7.6 Nm/degree (6.4-8.4) to 6.1 Nm/degree (1.5-10.3) following laminectomy. In the severely degenerated group, ETS decreased 22.3 % from 12.1 Nm/degree (4.6-21.9) to 9.4 Nm/degree (5.6-14.3) following laminectomy. In segments with low BMD, TMF was 40.7 % (p \ 0.001) lower than segments with high BMD [34.9 Nm (range 23.7-51.2) versus 58.9 Nm (range 43.8-79.2)]. Conclusions Laminectomy affects both torsion stiffness and torsion load to failure. In addition, torsional strength is strongly affected by BMD whereas disc degeneration affects torsional stiffness. Assessment of disc degeneration and BMD pre-operatively improves the understanding of the biomechanical effects of a lumbar laminectomy.

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Functional and quantitative magnetic resonance myelography of symptomatic stenoses of the lumbar spine

Eberhardt¹,

Ganslandt

Stadlbauer

2014

Neuroradiology

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Which factors prognosticate spinal instability following lumbar laminectomy?

Cited by 28 publications

References 26 publications

Which factors prognosticate rotational instability following lumbar laminectomy?

Which factors prognosticate rotational instability following lumbar laminectomy?

Torsion biomechanics of the spine following lumbar laminectomy: a human cadaver study

Functional and quantitative magnetic resonance myelography of symptomatic stenoses of the lumbar spine

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