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The Effects of Modified Cervical Laminoplasty With C3 Laminectomy on Motion and Stability: A Cadaveric Biomechanics
Richard C Lee1, Steven D Voinier2,3, Sennay G Ghenbot1
1Department of Orthopedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD.
Study Design:
Controlled laboratory study.
Objective:
The purpose of this study is to compare the mechanical stability of modified and traditional laminoplasties in multiple anatomic planes of motion.
Summary Of Background Data:
Traditional C3-C6 open-door laminoplasty is associated with postoperative axial pain and decreased range of motion (ROM). Modified laminoplasty with a C3 laminectomy is a promising technique that addresses these shortcomings. However, it is unclear whether this induces instability between C2 and C4.
Methods:
Sixteen cervical spine specimens were tested on a servohydraulic mechanical testing system (MTS) in flexion-extension, lateral bending, and axial rotation. The angular displacements of the total cervical spine (C2-C7) and the C2-C4 were tracked with the MTS and with Optotrak infrared triads. Each spine was tested in both its native state and after the assigned surgical treatment (n=8 traditional and n=8 modified). ROM and neutral zone (NZ) were calculated for each anatomic motion plane.
Results:
Compared with the native spine (1.00), traditional laminoplasty had significantly decreased relative flexion-extension ROM (0.86 total C-spine only) and NZ (0.78 total C-spine, 0.72 C2-C4), whereas modified laminoplasty did not (ROM 1.03 total C-spine, 1.10 C2-C4; NZ 1.02 total C-spine, 1.05 C2-C4). Modified laminoplasty had significantly larger relative ROM (1.15 total C-spine, 1.19 C2-C4) and NZ (1.18 total C-spine only) in axial rotation in the total cervical spine, whereas traditional laminoplasty did not (ROM 1.04 total C-spine, 1.02 C2-C4; NZ 1.00 total C-spine, 1.01 C2-C4).
Conclusions:
Modified laminoplasty does not destabilize the cervical spine in flexion-extension. Modified laminoplasty increases ROM and NZ in axial rotation, although its clinical implication remains unclear. Traditional laminoplasty from C3 to C6 significantly decreases ROM and NZ in flexion-extension.