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Which factors prognosticate spinal instability following lumbar laminectomy?
Arno Bisschop1, Barend J van Royen, Margriet G Mullender
1Department of Orthopedic Surgery, VU University Medical Center, Research Institute MOVE, De Boelelaan 1117, P.O. Box 7057, 1081 HV Amsterdam, The Netherlands.
Summary
Lumbar laminectomy significantly reduces spinal strength and stiffness. Bone mineral content, bone density, and disc geometry predict post-operative instability, highlighting the importance of these factors in surgical outcomes.
Area of Science:
- Biomechanical Engineering
- Orthopedic Surgery
- Spinal Anatomy
Background:
- Laminectomy can compromise lumbar spine stability.
- Understanding factors influencing post-laminectomy biomechanics is crucial for predicting instability.
Purpose of the Study:
- To identify parameters predicting shear biomechanical properties of the lumbar spine after laminectomy.
- To assess the impact of laminectomy on spinal motion segment strength and stiffness.
Main Methods:
- Human cadaveric lumbar spines underwent facet-sparing laminectomy.
- Radiographs, MRI, and DXA scans evaluated spinal geometry, degeneration, and bone mineral content/density.
- Dissected motion segments were tested in shear under axial compression to determine stiffness, yield force, and failure force.
Main Results:
- Laminectomy decreased shear stiffness (SS), shear yield force (SYF), and shear force to failure (SFF) by 24%, 41%, and 44%, respectively.
- Post-laminectomy SS correlated with disc and facet degeneration; SYF and SFF correlated with disc geometry and bone mineral content (BMC).
- Pre-operative BMC, bone mineral density (BMD), disc geometry, and degeneration predict post-operative biomechanical properties.
Conclusions:
- Reduced spinal strength and stiffness following laminectomy are predictable.
- Low BMC or BMD, small intervertebral discs, and absence of osteophytes may indicate increased risk of post-operative instability.
