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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.
Purpose:
Reduced strength and shear stiffness (SS) of lumbar motion segments following laminectomy may lead to instability. The purpose of the present study was to assess a broad range of parameters as potential predictors of shear biomechanical properties of the lumbar spine.
Methods:
Radiographs and MRI of all lumbar spines were obtained to classify geometry and degeneration of the motion segments. Additionally, dual X-ray absorptiometry (DXA) scans were performed to measure bone mineral content and density (BMC and BMD). Facet sparing lumbar laminectomy was performed either on L2 or L4, in 10 human cadaveric lumbar spines (mean age 72.1 years, range 53-89 years). Spinal motion segments were dissected (L2-L3 and L4-L5) and tested in shear, under simultaneously loading with 1600 N axial compression. Shear stiffness, shear yield force (SYF) and shear force to failure (SFF) were determined and statistical correlations with all parameters were established.
Results:
Following laminectomy, SS, SYF, and SFF declined (by respectively 24, 41, and 44%). For segments with laminectomy, SS was significantly correlated with intervertebral disc degeneration and facet joint degeneration (Pfirrmann: r = 0.64; Griffith: r = 0.70; Lane: r = 0.73 and Pathria: r = 0.64), SYF was correlated with intervertebral disc geometry (r = 0.66 for length; r = 0.66 for surface and r = 0.68 for volume), BMC (r = 0.65) and frontal area (r = 0.75), and SFF was correlated with disc length (r = 0.73) and BMC (r = 0.81). For untreated segments, SS was significantly correlated with facet joint tropism (r = 0.71), SYF was correlated with pedicle geometry (r = 0.83), and SFF was correlated with BMC (r = 0.85), BMD (r = 0.75) and frontal area (r = 0.75). SS, SYF and SFF could be predicted for segments with laminectomy (r (2) values respectively: 0.53, 0.81 and 0.77) and without laminectomy (r (2) value respectively: 0.50, 0.83 and 0.83).
Conclusions:
Significant loss of strength and SS are predicted by BMC, BMD, intervertebral disc geometry and degenerative parameters, suggesting that low BMC or BMD, small intervertebral discs and absence of osteophytes could predict the possible development of post-operative instability following lumbar laminectomy.
