Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Bone-Preserving Decompression Procedures Have a Minor Effect on the Flexibility of the Lumbar Spine

  • Costa, Francesco (Department of Neurosurgery, Humanitas Clinical and Research Center) ;
  • Ottardi, Claudia (LaBS, Department of Chemistry, Material and Chemical Engineering, Politecnico di Milano) ;
  • Volkheimer, David (Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre Ulm, Ulm University) ;
  • Ortolina, Alessandro (Department of Neurosurgery, Humanitas Clinical and Research Center) ;
  • Bassani, Tito (IRCCS Galeazzi Orthopedic Institute) ;
  • Wilke, Hans-Joachim (Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre Ulm, Ulm University) ;
  • Galbusera, Fabio (IRCCS Galeazzi Orthopedic Institute)
  • Received : 2018.01.26
  • Accepted : 2018.02.28
  • Published : 2018.11.01
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Abstract

Objective : To mitigate the risk of iatrogenic instability, new posterior decompression techniques able to preserve musculoskeletal structures have been introduced but never extensively investigated from a biomechanical point of view. This study was aimed to investigate the impact on spinal flexibility caused by a unilateral laminotomy for bilateral decompression, in comparison to the intact condition and a laminectomy with preservation of a bony bridge at the vertebral arch. Secondary aims were to investigate the biomechanical effects of two-level decompression and the quantification of the restoration of stability after posterior fixation. Methods : A universal spine tester was used to measure the flexibility of six L2-L5 human spine specimens in intact conditions and after decompression and fixation surgeries. An incremental damage protocol was applied : 1) unilateral laminotomy for bilateral decompression at L3-L4; 2) on three specimens, the unilateral laminotomy was extended to L4-L5; 3) laminectomy with preservation of a bony bridge at the vertebral arch (at L3-L4 in the first three specimens and at L4-L5 in the rest); and 4) pedicle screw fixation at the involved levels. Results : Unilateral laminotomy for bilateral decompression had a minor influence on the lumbar flexibility. In flexion-extension, the median range of motion increased by 8%. The bone-preserving laminectomy did not cause major changes in spinal flexibility. Two-level decompression approximately induced a twofold destabilization compared to the single-level treatment, with greater effect on the lower level. Posterior fixation reduced the flexibility to values lower than in the intact conditions in all cases. Conclusion : In vitro testing of human lumbar specimens revealed that unilateral laminotomy for bilateral decompression and bone-preserving laminectomy induced a minor destabilization at the operated level. In absence of other pathological factors (e.g., clinical instability, spondylolisthesis), both techniques appear to be safe from a biomechanical point of view.

Keywords

References

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