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Cervical stability after foraminotomy. A biomechanical in vitro analysis
T A Zdeblick1, D Zou, K E Warden
1Division of Orthopedic Surgery, University of Wisconsin, Madison.
The Journal of Bone and Joint Surgery. American Volume
|January 1, 1992
Summary
Cervical spine stability is compromised after facetectomy, especially with over 50% facet resection during foraminotomy. This can lead to segmental hypermobility, impacting spinal cord and nerve root decompression outcomes.
Area of Science:
- Orthopedic Surgery
- Biomechanical Engineering
- Spinal Anatomy
Background:
- Laminectomy and facetectomy are surgical procedures for cervical spine decompression.
- Assessing the biomechanical impact of these procedures is crucial for patient outcomes.
Purpose of the Study:
- To evaluate the acute stability of the cervical spine after laminectomy and progressive facetectomies.
- To determine the threshold of facet resection that compromises cervical spine stability.
Main Methods:
- Twelve human cadaveric cervical spines were used for in vitro biomechanical testing.
- Specimens were tested intact, after C5 laminectomy, and after staged C6 foraminotomy with 25%, 50%, 75%, and 100% facet resection.
- Testing included axial load, flexion-extension, and torsional moments.
Main Results:
- Torsional stiffness significantly decreased with >50% facet resection.
- Posterior strain increased with facetectomy: 2.5% at 50% resection, 25% at 75-100% resection.
- Cervical spine segmental hypermobility occurred with >50% facet resection.
Conclusions:
- Resection of more than 50% of the cervical facet joint during foraminotomy leads to significant instability.
- This instability can result in segmental hypermobility, potentially affecting surgical outcomes for spinal cord or nerve root decompression.