Experimental ex vivo characterization of the biomechanical effects of laminectomy and posterior fixation of the lumbo-sacral spine

Abstract

Laminectomy and posterior fixation are well-established surgical techniques to decompress nervous structures in case of lumbar spinal stenosis. While laminectomy is suspected to increase the instability of the spine, posterior fixation is associated with some complications such as adjacent segment degeneration. This study aimed to investigate how laminectomy and posterior fixation alter the biomechanics of the lumbar spine in terms of range of motion (ROM) and strains on the intervertebral discs. Twelve L2-S1 cadaveric spines were mechanically tested in flexion, extension, and lateral bending in the intact condition, after two-level laminectomy and after L4-S1 posterior fixation. The ROM of the spine segment was measured in each spine condition, and each loading configuration. The strain distribution on the surface of all the intervertebral discs was measured with Digital Image Correlation. Laminectomy significantly increased the ROM in flexion (p = 0.028) and lateral bending (p = 0.035). Posterior fixation decreased the ROM in all the loading configurations. Laminectomy did not significantly modify the strain distribution in the discs. Posterior fixation significantly increased the principal tensile and compressive strains in the disc adjacent the fixation both in flexion and in lateral bending. These findings can elucidate one of the clinical causes of the adjacent segment degeneration onset.