Biomechanical Evaluation of the Extensor Musculature of the Cervical Spine

Nolan, John P.; Sherk, Henry H.

doi:10.1097/00007632-198801000-00003

Cited by 201 publications

(106 citation statements)

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“…Therefore, we were unable to address the role of the deep extensor musculature, which may 7,8,10,13,17,22,23,25 or may not 22 contribute to axial neck pain. Furthermore, although preservation of the terminal ligaments may confer biomechanical stability, this cadaveric study cannot address long-term sequelae of more stabilized cervical vertebrae, especially at C2-3, which can become ossified after laminoplasty, 23 possibly conveying recalcitrant stenosis at this level.…”

Section: Discussionmentioning

confidence: 99%

Biomechanics of open-door laminoplasty with and without preservation of posterior structures

Healy¹,

Lubelski

West

et al. 2016

Journal of Neurosurgery: Spine

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laboratory iNveStigatioNC erviCal open-door laminoplasty (ODL) decompresses the spinal canal while maintaining nearphysiological cervical range of motion (ROM). In contrast to a standard laminectomy, which leads to postlaminectomy kyphosis in 15%-43% of cases, ODL is purported to reduce this adverse outcome. 2,3,5,16,28 Despite these advantages, reports have shown that ODL may lead to persistent neck and shoulder pain, progressive loss of ROM, and progressive cervical kyphosis. [6][7][8]11,29 There are various approaches used to perform cervical laminoplasty, many of which involve spinous process resection and disruption of intervening interspinales musculature and supraspinous ligaments (intraspinous and supraspinous ligaments [ISLs]). 5,9,20 Alternative methods have been reported that retain the dorsal ligamentous complex, and small cohorts have shown it may protect from loss of sagittal balance, while not statistically reducing cervical ROM. obJective Cervical open-door laminoplasty (ODL) is designed to decompress the spinal cord, maintain motion, and prevent postlaminectomy kyphosis. Many traditional laminoplasty techniques involve disruption of the posterior ligamentous structures, most notably the C7-T1 supraspinous ligament and interspinales muscle complex (intraspinous and supraspinous ligaments [ISLs]). methodS Eight human cervical cadaveric specimens (C2-T1) were used to investigate the subaxial kinematics following ODL with varying degrees of posterior element disruption. Ligamentous integrity was preserved and specimens were tested utilizing force control in flexion-extension (FE), lateral bending (LB), and axial rotation (AR) in the native state, and following 1) C3-7 ODL, 2) ODL with terminal ISL resection, 3) ODL with C3-7 spinous process resection, and 4) C3-7 laminectomy. Range of motion (ROM) was measured across C2-T1, "global," and at the segmental level. reSultS Compared with ODL, sectioning the terminal ISLs resulted in global ROM increases by 7.9% in FE, 2.4% in LB, and 5.6% in AR (p > 0.05), whereas laminectomy increased global ROM by 36.0% in FE (p = 0.002) and a 26.3% increase in AR ROM (p = 0.01). When considering segmental ROM, resection of the terminal ISLs increased ROM in FE by 36.5% at C2-3 (p = 0.019) and 25.4% at C7-T1 (p > 0.05). Segmental increases following C3-7 spinous process resection averaged less than 3% per level, compared with up to 40% increases in ROM per level after laminectomy. coNcluSioNS Laminectomy resulted in the greatest increase in global cervical ROM. Resection of the ISLs at C2-3 and C7-T1 increased segmental ROM at these specific levels to a similar extent that laminectomy increased ROM at each cervical level. This segmental ROM may contribute to pain or postprocedural deformity and highlights the importance of the ISLs at the terminal ends of the ODL.

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Section: Discussionmentioning

confidence: 99%

Biomechanics of open-door laminoplasty with and without preservation of posterior structures

Healy¹,

Lubelski

West

et al. 2016

Journal of Neurosurgery: Spine

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“…The semispinalis cervicis is attached proximally to the spinous process of the C2-C5 vertebra and distally to the transverse process of the T1-T6 vertebra [29] and acts as the dynamic stabilizer of the cervical spine [23]. Recent studies revealed that preservation of the semispinalis cervicis attachment to C2 is important for reducing post-laminoplasty axial symptoms including neck and shoulder-girdle pain and maintaining sagittal alignment [15,16,33].…”

Section: Discussionmentioning

confidence: 99%

Cross-sectional area of posterior extensor muscles of the cervical spine in asymptomatic subjects: a 10-year longitudinal magnetic resonance imaging study

et al. 2011

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There has been no prospective study on agerelated changes of the extensor muscles of the cervical spine in healthy subjects. This study was conducted to elucidate any association between the changes in cross-sectional area of the extensor muscles of the cervical spine on MRIs and cervical disc degeneration or the development of clinical symptoms. Sixty-two subjects who underwent MR imaging by a 1.5-Tesla machine between 1993 and 1996 as asymptomatic volunteers in a previous study were recruited again 10 years later for this follow-up study. The mean interval between the studies was 11.0 ± 0.7 years. The cross-sectional areas of the multifidus, semispinalis cervicis, semispinalis capitis, and splenius capitis at C3-C4, C4-C5, and C5-C6 intervertebral levels were measured on T2-weighted axial images using Image J 1.42. The mean cross-sectional areas of the deep extensor muscles were 1,396.8 ± 337.6 mm 2 at the C3-C4 level, 1,514.7 ± 381.0 mm 2 at the C4-C5 level, and 1,542.8 ± 373.5 mm 2 at the C5-C6 level in the previous investigation. The cross-sectional areas were 1,498.7 ± 374.4 mm 2 at the C3-C4 level, 1,569.9 ± 390.9 mm 2 at the C4-C5 level, and 1,599.6 ± 364.3 mm 2 at the 10-year follow-up. An increase in the cross-sectional area of the muscles was more frequently observed in subjects in their tens to thirties in the initial study, while a decrease was more frequently observed in those in their forties and older in the initial study. Disc degeneration was not correlated with a change in extensor muscle volume. Development of shoulder stiffness during follow-up was significantly negatively correlated with a change in the cross-sectional area of the deep extensor muscles.

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“…Moreover, objective data showed that the postoperative O-C7 angles at extension or the rotation ROM in Group A were significantly larger than those in Group B, as if to corroborate the clinical data. Because most of the SSC inserts into the C2 spinous process [19] and acts as an important extensor of the cervical spine [4,5,27], the posterior approach preserving the SSC inserted into the C2 spinous process might cause the larger angle at extension and the reduction of limitations of ADL accompanying extension. On the other hand, Takeuchi et al [25] evaluating prospectively the cross-sectional areas of the cervical posterior muscles after laminoplasty preserving or reattaching the SSC inserted into C2, reported that preservation of only the SSC inserted into C2 maintained the whole cervical posterior muscular volume well.…”

Section: Discussionmentioning

confidence: 99%

“…To expose the C3 lamina completely during C3-C7 laminoplasty, it generally is necessary to detach the semispinalis cervicis (SSC) from the C2 spinous process and then reattach it at the time of closure. The SSC, most of which inserts into the C2 spinous process [19], act as an extensor of the cervical spine [4,5,27]. For complete preservation of the SSC inserted in C2, therefore, the authors changed the laminoplastic procedure from C3-C7 laminoplasty to C4-C7 laminoplasty with C3 laminectomy in 2001 [25].…”

Section: Introductionmentioning

confidence: 99%

Limitation of activities of daily living accompanying reduced neck mobility after laminoplasty preserving or reattaching the semispinalis cervicis into axis

et al. 2007

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Although difficulties with neck mobility often interfere with patients' activities of daily living (ADL) after cervical laminoplasty, there was no detailed study on the relation between the limitations of ADL accompanying postoperative reduced neck mobility and the cervical posterior approach. The aim of this study was to compare retrospectively the frequency of limitations of ADL accompanying neck mobility after laminoplasty preserving the semispinalis cervicis inserted into the C2 spinous process with that after laminoplasty reattaching the muscle to C2. Forty-nine patients after C4-C7 laminoplasty with C3 laminectomy preserving the semispinalis cervicis inserted into C2 (Group A) and 24 patients after C3-C7 laminoplasty reattaching the muscle (Group B) were evaluated. The frequency of postoperative limitations of ADL accompanying each of three neck movements of extension, flexion and rotation were investigated. The postoperative O-C7 angles at extension and flexion was measured on lateral extension and flexion radiographs of the cervical spine, respectively. The postoperative cervical range of motion in rotation was measured in the cranial view using a digital camera. Frequency of limitations of ADL accompanying extension was lower (P = 0.037) in Group A (2%) than in Group B (17%). Frequency of limitations of ADL accompanying flexion was similar in Group A (8%) and Group B (4%). Frequency of limitations of ADL accompanying rotation was lower (P = 0.031) in Group A (12%) than in Group B (33%). Average O-C7 angle at extension was significantly larger (P = 0.002) in Group A (147°) than in Group B (136°). Average O-C7 angle at flexion was similar in Group A (93°) and Group B (91°). Average range of motion in rotation was significantly larger (P = 0.004) in Group A (110°) than in Group B (91°). This retrospective study suggested that the frequency of limitations of ADL accompanying neck extension or rotation was lower after laminoplasty preserving the semispinalis cervicis inserted into C2 than after laminoplasty reattaching the muscle.

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Biomechanical Evaluation of the Extensor Musculature of the Cervical Spine

Cited by 201 publications

References 0 publications

Biomechanics of open-door laminoplasty with and without preservation of posterior structures

Biomechanics of open-door laminoplasty with and without preservation of posterior structures

Cross-sectional area of posterior extensor muscles of the cervical spine in asymptomatic subjects: a 10-year longitudinal magnetic resonance imaging study

Limitation of activities of daily living accompanying reduced neck mobility after laminoplasty preserving or reattaching the semispinalis cervicis into axis

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