Biomechanical effects of laminectomies in the human lumbar spine: a finite element study

التفاصيل البيبلوغرافية
العنوان: Biomechanical effects of laminectomies in the human lumbar spine: a finite element study
المؤلفون: Nicholas Spina, Genesis S. Moreno, Benjamin J. Ellis, Darrel S. Brodke, Sean M. Finley
المصدر: The Spine Journal. 21:150-159
بيانات النشر: Elsevier BV, 2021.
سنة النشر: 2021
مصطلحات موضوعية: musculoskeletal diseases, medicine.medical_treatment, Finite Element Analysis, Population, Context (language use), 03 medical and health sciences, 0302 clinical medicine, Pars interarticularis, Humans, Medicine, Orthopedics and Sports Medicine, Range of Motion, Articular, education, Orthodontics, 030222 orthopedics, education.field_of_study, Lumbar Vertebrae, business.industry, Laminectomy, Intervertebral disc, musculoskeletal system, medicine.disease, Spondylolisthesis, Biomechanical Phenomena, medicine.anatomical_structure, Surgery, Cortical bone, Neurology (clinical), business, Range of motion, 030217 neurology & neurosurgery
الوصف: BACKGROUND CONTEXT Previous studies have analyzed the effect of laminectomy on intervertebral disc (IVD), facet-joint-forces (FJF), and range of motion (ROM), while only two have specifically reported stresses at the pars interarticularis (PI) with posterior element resection. These studies have been performed utilizing a single subject, questioning their applications to a broader population. PURPOSE We investigate the effect of graded PI resection in a three-dimensional manner on PI stress to provide surgical guidelines for avoidance of iatrogenic instability following lumbar laminectomy. Additionally, quantified FJF and IVD stresses can provide further insight into the development of adjacent segment disease. STUDY DESIGN Biomechanical finite element (FE) method investigation of the lumbar spine. METHODS FE models of the lumbar spine of three subjects were created using the open-source finite element software, FEBio. Single-level laminectomy, two-level laminectomy, and ventral-to-dorsal PI resection simulations were performed with varying degrees of PI resection from 0% to 75% of the native PI. These models were taken through cardinal ROM under standard loading conditions and PI stresses, FJF, IVD stresses, and ROM were analyzed. RESULTS The three types of laminectomy simulated in this study showed a nonlinear increase in PI stress with increased bone resection. Axial rotation generated the most stress at the PI followed by flexion, extension and lateral bending. At 75% bone resection all three types of laminectomy produced PI stresses that were near the ultimate strength of human cortical bone during axial rotation. FJF decreased with increased bone resection for the three laminectomies simulated. This was most notable in axial rotation followed by extension and lateral bending. IVD stresses varied greatly between the nonsurgical models and likewise the effect of laminectomy on IVD stresses varied between subjects. ROM was mostly unaffected by the laminectomies performed in this study. CONCLUSIONS Regarding the risk of iatrogenic spondylolisthesis, the combined results are sufficient evidence to suggest surgeons should be particularly cautious when PI resection exceeds 50% bone resection for all laminectomies included in this study. Lastly, the effects seen in FJF and IVD stresses indicate the degree to which the remainder of the spine must experience compensatory biomechanical changes as a result of the surgical intervention.
تدمد: 1529-9430
DOI: 10.1016/j.spinee.2020.07.016
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::f5a85001f022a57088771f38c5f6cc35
https://doi.org/10.1016/j.spinee.2020.07.016
Rights: CLOSED
رقم الانضمام: edsair.doi.dedup.....f5a85001f022a57088771f38c5f6cc35
قاعدة البيانات: OpenAIRE
الوصف
تدمد:15299430
DOI:10.1016/j.spinee.2020.07.016