| The effect of bilateral laminotomy versus laminectomy on the motion and stiffness of the human lumbar spine: a biomechanical comparison. | |
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MedLine Citation:
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PMID: 20562732 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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STUDY DESIGN: A cadaveric simulation model of the lumbar spine was used to study the intervertebral motion characteristics of the lumbar spine after bilateral laminotomy and facet-sparing laminectomy. OBJECTIVE: To assess differences in motion patterns and lumbar spine stiffness after bilateral laminotomy versus laminectomy. SUMMARY OF BACKGROUND DATA: Spondylolisthesis after facet-sparing laminectomy has been reported with a frequency of 8% to 31%. Bilateral laminotomies have been shown to be effective in decompressing the spine, without resection of the posterior osteo-ligamentous complex. We hypothesize that bilateral laminotomies induce significantly less iatrogenic hypermobility and less stiffness reduction than a traditional facet-sparing laminectomy in the lumbar spine. METHODS: Six fresh frozen human cadaveric lumbar spines (L1-L5) were mounted into a spine motion simulator for testing. With physiologic follower preload, flexion/extension, lateral bending, and axial rotation moments were applied to the lumbar spine in 3 trials: (1) Intact lumbar spine-no surgery, (2) Lumbar spine after bilateral lumbar laminotomies at L2-L5, (3) Lumbar spine after full laminectomies at L2-L5. The lumbar spine kinematics were measured using a Vicon motion tracking system. Total and segmental range of motion and spine stiffness were recorded. RESULTS: In flexion/extension, bilateral laminotomies resulted in an average increase in L2-L5 range of flexion/extension motion of 14.3%, whereas a full laminectomy resulted in an increase of 32.0% (P<0.05). Analysis per level demonstrated roughly twofold increase in motion with laminectomy compared with bilateral laminotomies (P<0.05, at every treated level). Stiffness was decreased by an average of 11.8% after the 3-level-laminotomies and by 27.2% (P<0.05) after the 3-level-laminectomy. CONCLUSION: These data demonstrate that bilateral laminotomies induce significantly less hypermobility and less stiffness reduction compared with a full laminectomy. The preservation of the central posterior osteo-ligamentous structures may provide a stabilizing effect in preventing postdecompression spondylolisthesis. |
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Authors:
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Michael J Lee; Richard J Bransford; Carlo Bellabarba; Jens R Chapman; Amy M Cohen; Richard M Harrington; Randal P Ching |
Publication Detail:
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Type: Comparative Study; Journal Article |
Journal Detail:
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Title: Spine Volume: 35 ISSN: 1528-1159 ISO Abbreviation: Spine Publication Date: 2010 Sep |
Date Detail:
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Created Date: 2010-09-02 Completed Date: 2010-12-20 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7610646 Medline TA: Spine (Phila Pa 1976) Country: United States |
Other Details:
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Languages: eng Pagination: 1789-93 Citation Subset: IM |
Affiliation:
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University of Washington Medical Center, Department of Sports Medicine and Orthopaedic Surgery, Seattle, WA 98195, USA. jihoon2000@hotmail.com |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Biomechanics Cadaver Decompression, Surgical / adverse effects, methods* Humans Joint Instability / etiology, physiopathology, prevention & control Laminectomy / adverse effects, methods* Lumbar Vertebrae / physiopathology, surgery* Range of Motion, Articular Spondylolisthesis / etiology, physiopathology, prevention & control |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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