Abstract
PurposeTo evaluate biomechanical differences between two surgical procedures for cervical open-door laminoplasty using human cadaveric spines.MethodsTwenty-four cervical vertebrae (C4-C6) from eight fresh-frozen human cervical spines were subjected to mechanical testing after being instrumented for open-door laminoplasty using a newly designed plate-spacer device with a monocoque structure (plate-spacer group; n = 12) or by conventional miniplate-alone fixation (miniplate group; n = 12). Cantilever bending testing was performed by applying a compressive load in the cranio-caudal direction to the base of the spinous process of the reconstructed laminar arch constructs until failure and strength and stiffness of the laminar arch were determined. The results are presented as mean ± standard deviation.ResultsThe plate-spacer group was approximately twice as strong as the miniplate group (27.6 ± 16.5 N vs. 13.5 ± 7.3 N, p < 0.05). Stiffness in the plate-spacer group exhibited the same trend (19.6 ± 9.3 N/mm vs. miniplate group: 11.4 ± 6.9 N/mm, p < 0.05).ConclusionThe fixation with the monocoque plate-spacer construct for open-door laminoplasty provided higher structural properties when compared against the plate-alone fixation. The spacer in the plate-spacer construct appears to contribute by preventing large deformations of the laminar arch caused by bending in cranio-caudal direction. Future studies will be required to investigate stress/strain distribution in the laminar arch constructs.
Highlights
Multilevel cervical cord compression and myelopathy caused by degenerative diseases such as spondylosis and ossification of posterior longitudinal ligament is usually treated with posterior decompression surgical approaches
The fixation with the monocoque plate-spacer construct for open-door laminoplasty provided higher structural properties when compared against the plate-alone fixation
The spacer in the plate-spacer construct appears to contribute by preventing large deformations of the laminar arch caused by bending in cranio-caudal direction
Summary
Multilevel cervical cord compression and myelopathy caused by degenerative diseases such as spondylosis and ossification of posterior longitudinal ligament is usually treated with posterior decompression surgical approaches. Cervical laminoplasty has gradually become a well-established surgical intervention since first introduction in 1983 [1]. Cervical laminoplasty was developed in response to the disadvantages presented by cervical laminectomy, including postoperative spinal instability causing kyphotic deformity and recurrent spinal canal compression by postoperative laminectomy membrane [1, 2]. In the original laminoplasty procedure outlined by Hirabayashi the lamina is reconstructed by using suture fixation. While long-term neurological results after cervical laminoplasty with suture fixation have been reported to be satisfactory [3, 4], lamina closure has been noted as a problem associated with this procedure. Matsumoto et al reported that up to 34% of patients had some degree of closure of the lamina at one or more levels after laminoplasty using the suture fixation [5]
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