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01-08-2013 | Original Article

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

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

Published in: European Spine Journal | Issue 8/2013

Abstract

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 (≥median BMD) or low BMD (<median BMD). Laminectomy was performed either on L2 (5×) or L4 (5×). 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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Title: Torsion biomechanics of the spine following lumbar laminectomy: a human cadaver study
Authors: Arno Bisschop
Jaap H. van Dieën
Idsart Kingma
Albert J. van der Veen
Timothy U. Jiya
Margriet G. Mullender
Cornelis P. L. Paul
Marinus de Kleuver
Barend J. van Royen
Publication date: 01-08-2013
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 8/2013
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-013-2699-3

At a glance: The STEP trials

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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