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Maximum Safety Limits of Laminectomy of the C1 Vertebra for Chiari Malformation Surgery: A Finite Element Analysis

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Abstract

Background

The treatment of Chiari malformations generally consists of posterior fossa decompression. C1 laminectomy is required in selected cases. However, cases of iatrogenic anterior arch fractures at C1 without high-energy trauma have been reported. Developing theoretical models of atlas C1 bones that have undergone a laminectomy can help researchers identify the regions where fractures may occur as a result of sudden loads.

Methods

In this study, we created a detailed three-dimensional solid finite element model of the human atlas bone (C1) using geometric data. The loadings of the laminectomy dimension were evaluated on the basis of three groups. Group I comprised atlas bones that had not undergone a laminectomy. For Group II, the lateral border of the laminectomy was determined as the projection of the lateral mass medial border on the lamina. For Group III, the bilateral sulcus arteriosus was determined as the border for the lateral border of the laminectomy. The analysis results, which are in good agreement with those of previous reports, showed high concentrations of localized stress in the anterior and posterior arches of the atlas bone.

Results

The analysis results showed that the stress increased in the laminectomy models. The maximum stress observed was consistent with the clinical observations of fracture sites in previous studies.

Conclusion

In the treatment of patients with Chiari malformations, C1 laminectomy is often required. The width of this laminectomy can lead to iatrogenic anterior arch fractures. This is the first study to evaluate C1 laminectomy width using finite element modeling.

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Data availability statement

The original contributions presented in the study are included in the article, further inquiries can be directed to the corresponding author.

Abbreviations

CMT1:

Chiari malformation type 1

CSF:

Cerebrospinal fluid

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Neurosurgery, Health Sciences University, Haydarpasa Training and Research Hospital, Uskudar, Istanbul, Turkey

    Ali Erhan Kayalar & Arif Tarkan Çalışaneller

  2. Department of Neurosurgery, Health Sciences University, Umraniye Training and Research Hospital, Umraniye, Istanbul, Turkey

    Cumhur Kaan Yaltırık

  3. Department of Machinery, Istanbul Gelisim Vocational School, Istanbul, Turkey

    Enes Kalyoncu

  4. Faculty of Mechanical Engineering, Yıldız Technical University, Istanbul, Turkey

    Berna Bolat & Birgül Ascioglu Temiztas

  5. Department of Neurosurgery, Siverek State Hospital, Şanlıurfa, Turkey

    Mustafa Umut Etli

  6. Department of Neurosurgery, İstanbul Brain and Spine Center, Istanbul, Turkey

    Sait Naderi

Authors
  1. Ali Erhan Kayalar
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by AEK, EK, BAT, BB. The first draft of the manuscript was written by AEK, CKY, MUE, ATÇ, and SN contributed to the editing and reviewing of the manuscript during the revision phase. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Ali Erhan Kayalar.

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The authors have no relevant financial or non-financial interests to disclose.

Ethical Approval

This is an observational study. The Umraniye Training and Research Hospital Ethics Committee has confirmed that no ethical approval is required.

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This study does not include patient data

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Kayalar, A.E., Yaltırık, C.K., Kalyoncu, E. et al. Maximum Safety Limits of Laminectomy of the C1 Vertebra for Chiari Malformation Surgery: A Finite Element Analysis. JOIO 57, 884–890 (2023). https://doi.org/10.1007/s43465-023-00870-1

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  • DOI: https://doi.org/10.1007/s43465-023-00870-1

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