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Biomechanical comparison of laminectomy, hemilaminectomy and a new minimally invasive approach in the surgical treatment of multilevel cervical intradural tumour: a finite element analysis

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Abstract

Purpose

The objective of this study was to investigate the impact of the less invasive procedures of hemilaminectomy and unilateral multilevel interlaminar fenestration (UMIF) on the cervical spinal biomechanics.

Methods

A validated nonlinear finite element model of the intact cervical spine (C2–C7) was modified to study the biomechanical changes as a result of surgical alteration for treatment of intradural tumours at C3–6 using multilevel laminectomy (ML), multilevel hemilaminectomy (MHL) and UMIF with or without unilateral graded facetectomy.

Results

Under the load-controlled method, the greatest biomechanical changes occurred at the surgical segments. The largest increases occurred in flexion motions following ML approach with 70, 62 and 60 % increase at C3–4, C4–5 and C5–6, respectively. The increases were significantly reduced to no more than 14 % under MHL and UMIF. When combined with graded facetectomy, the changes in flexion under ML approach have a significantly further increase, up to 110 % at C3–4. The further increase was not significantly following MHL and UMIF, with no more than 31 % increase at C3–4, C4–5 and C5–6. The motion following UMIF was only slightly smaller in axial rotation than MHL. The maximum stresses in the annulus occurred during flexion in ML model, with 39, 34 and 38 % more stress than the intact at C3–4, C4–5 and C5–6, respectively. The increases of stress were significantly reduced to 5–7 % under MHL and UMIF.

Conclusions

The less invasive approaches of UMIF and MHL greatly preserved the flexion motion (more than 48 %) of the cervical spine compared with laminectomy, and the preserved motion mean the low-risk of postoperative spinal instability. UMIF and MHL also reduced the increased stress of annulus caused by ML, and the lesser stress will lower the risk of postoperative disc degeneration. The posterior bone elements play a slight role in spinal stability after removal of the attached ligaments.

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Acknowledgments

The authors received no financial support for conducting this study or publication of the findings.

Conflict of interest

No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

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Authors and Affiliations

  1. Department of Neurosurgery, Changzheng Hospital, Second Military Medical University, No. 415 FengYang Road, Shanghai, 200003, China

    Tianhao Xie, Jun Qian, Yicheng Lu, Yikun Jiang & Chun Luo

  2. Institute of Traumatology and Orthopaedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China

    Bo Chen

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  1. Tianhao Xie
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  2. Jun Qian
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  3. Yicheng Lu
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  4. Bo Chen
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  5. Yikun Jiang
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Corresponding authors

Correspondence to Yicheng Lu or Chun Luo.

Additional information

T. Xie and J. Qian contributed equally to this manuscript.

The manuscript submitted does not contain information about medical device(s)/drug(s).

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Xie, T., Qian, J., Lu, Y. et al. Biomechanical comparison of laminectomy, hemilaminectomy and a new minimally invasive approach in the surgical treatment of multilevel cervical intradural tumour: a finite element analysis. Eur Spine J 22, 2719–2730 (2013). https://doi.org/10.1007/s00586-013-2992-1

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  • DOI: https://doi.org/10.1007/s00586-013-2992-1

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