Which factors prognosticate spinal instability following lumbar laminectomy?
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.
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.
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).
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.
- Bisschop A, Mullender MG, Kingma I, Jiya TU, van der Veen AJ, Roos JC et al. (2011) The impact of bone mineral density and disc degeneration on shear strength and stiffness of the lumbar spine following laminectomy. Eur Spine J (Epub ahead of print)
- Boden, SD, Riew, KD, Yamaguchi, K, Branch, TP, Schellinger, D, Wiesel, SW (1996) Orientation of the lumbar facet joints: association with degenerative disc disease. J Bone Joint Surg Am 78: pp. 403-411
- Brinckmann, P, Biggemann, M, Hilweg, D (1989) Prediction of the compressive strength of human lumbar vertebrae. Spine (Phila Pa 1976) 14: pp. 606-610 CrossRef
- Farfan, HF (1984) The torsional injury of the lumbar spine. Spine (Phila Pa 1976) 9: pp. 53 CrossRef
- Griffith, JF, Wang, YX, Antonio, GE, Choi, KC, Yu, A, Ahuja, AT (2007) Modified Pfirrmann grading system for lumbar intervertebral disc degeneration. Spine (Phila Pa 1976) 32: pp. E708-E712 CrossRef
- Hansraj, KK, Cammisa, FP, O’Leary, PF, Crockett, HC, Fras, CI, Cohen, MS (2001) Decompressive surgery for typical lumbar spinal stenosis. Clin Orthop Relat Res 384: pp. 10-17 CrossRef
- Herkowitz, HN, Kurz, LT (1991) Degenerative lumbar spondylolisthesis with spinal stenosis. A prospective study comparing decompression with decompression and intertransverse process arthrodesis. J Bone Joint Surg Am 73: pp. 802-808
- Jansson, KA, Nemeth, G, Granath, F, Blomqvist, P (2005) Spinal stenosis re-operation rate in Sweden is 11% at 10 years—a national analysis of 9,664 operations. Eur Spine J 14: pp. 659-663 CrossRef
- Kettler, A, Wilke, HJ (2006) Review of existing grading systems for cervical or lumbar disc and facet joint degeneration. Eur Spine J 15: pp. 705-718 CrossRef
- Kingma, I, Bosch, T, Bruins, L, Dieen, JH (2004) Foot positioning instruction, initial vertical load position and lifting technique: effects on low back loading. Ergonomics 13: pp. 1365-1385 CrossRef
- Kingma, I, Faber, GS, Bakker, AJ, Dieen, JH (2006) Can low back loading during lifting be reduced by placing one leg beside the object to be lifted?. Phys Ther 86: pp. 1091-1105
- Kingma, I, Staudenmann, D, Dieen, JH (2007) Trunk muscle activation and associated lumbar spine joint shear forces under different levels of external forward force applied to the trunk. J Electromyogr Kinesiol 17: pp. 14-24 CrossRef
- Lane, NE, Nevitt, MC, Genant, HK, Hochberg, MC (1993) Reliability of new indices of radiographic osteoarthritis of the hand and hip and lumbar disc degeneration. J Rheumatol 20: pp. 1911-1918
- Leone, A, Guglielmi, G, Cassar-Pullicino, VN, Bonomo, L (2007) Lumbar intervertebral instability: a review. Radiology 245: pp. 62-77 CrossRef
- Modic, MT, Steinberg, PM, Ross, JS, Masaryk, TJ, Carter, JR (1988) Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology 166: pp. 193-199
- Pathria, M, Sartoris, DJ, Resnick, D (1987) Osteoarthritis of the facet joints: accuracy of oblique radiographic assessment. Radiology 164: pp. 227-230
- Pfirrmann, CW, Metzdorf, A, Zanetti, M, Hodler, J, Boos, N (2001) Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976) 26: pp. 1873-1878 CrossRef
- Pfirrmann, CW, Resnick, D (2001) Schmorl nodes of the thoracic and lumbar spine: radiographic-pathologic study of prevalence, characterization, and correlation with degenerative changes of 1,650 spinal levels in 100 cadavers. Radiology 219: pp. 368-374
- Quint, U, Wilke, HJ (2008) Grading of degenerative disk disease and functional impairment: imaging versus patho-anatomical findings. Eur Spine J 17: pp. 1705-1713 CrossRef
- Quint, U, Wilke, HJ, Loer, F, Claes, L (1998) Laminectomy and functional impairment of the lumbar spine: the importance of muscle forces in flexible and rigid instrumented stabilization—a biomechanical study in vitro. Eur Spine J 7: pp. 229-238 CrossRef
- Renau, A, Farrerons, J, Yoldi, B, Gil, J, Proubasta, I, Llauger, J (2004) Yield point in prediction of compressive behavior of lumbar vertebral body by dual-energy X-ray absorptiometry. J Clin Densitom 7: pp. 382-389 CrossRef
- Dieen, JH, Kingma, I (2005) Effects of antagonistic co-contraction on differences between electromyography based and optimization based estimates of spinal forces. Ergonomics 48: pp. 411-426 CrossRef
- Dieen, JH, Veen, AJ, Royen, BJ, Kingma, I (2006) Fatigue failure in shear loading of porcine lumbar spine segments. Spine (Phila Pa 1976) 31: pp. E494-E498 CrossRef
- Solinge, GB, Veen, AJ, Dieen, JH, Kingma, I, Royen, BJ (2010) Anterior shear strength of the porcine lumbar spine after laminectomy and partial facetectomy. Eur Spine J 19: pp. 2130-2136 CrossRef
- Laar, W, Meester, RJ, Smit, TH, Royen, BJ (2007) A biomechanical analysis of the self-retaining pedicle hook device in posterior spinal fixation. Eur Spine J 16: pp. 1209-1214 CrossRef
- Weishaupt, D, Zanetti, M, Boos, N, Hodler, J (1999) MR imaging and CT in osteoarthritis of the lumbar facet joints. Skeletal Radiol 28: pp. 215-219 CrossRef
- Wilke, HJ, Rohlmann, F, Neidlinger-Wilke, C, Werner, K, Claes, L, Kettler, A (2006) Validity and interobserver agreement of a new radiographic grading system for intervertebral disc degeneration: part I. Lumbar spine. Eur Spine J 15: pp. 720-730 CrossRef
- Which factors prognosticate spinal instability following lumbar laminectomy?
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European Spine Journal
Volume 21, Issue 12 , pp 2640-2648
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- Degenerative spondylolisthesis
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- 1. Department of Orthopedic Surgery, VU University Medical Center, Research Institute MOVE, De Boelelaan 1117, P.O. Box 7057, 1081 HV, Amsterdam, The Netherlands
- 2. Faculty of Human Movement Sciences, Research Institute MOVE, VU University Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
- 3. Department of Physics and Medical Technology, VU University Medical Center, De Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands