Effect of posterior decompression extent on biomechanical parameters of the spinal cord in cervical ossification of the posterior longitudinal ligament

Khuyagbaatar, Batbayar; Kim, Kyung-Soo; Park, Won Man; Kim, Yoon Hyuk

doi:10.1177/0954411916637383

Cited by 13 publications

(25 citation statements)

References 48 publications

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“…Kim et al and Khuyagbaatar et al also reported von Mises stresses of 0 -400 kPa at similar compression ratios. 83,106 This is higher than the stresses we reported, but again, at a much higher amount of compression.…”

Section: Discussioncontrasting

confidence: 66%

“…86 It is interesting that all these FE models report similar strain levels even though There are FE models which address the effects of cervical myelopathy. 79,82,83,106,108 However, the majority of these, as previously mentioned, have simplified boundary conditions. Khuyagbaatar et al is the first group to incorporate comprehensive spinal canal anatomy with the spinal cord to investigate cord compression caused by the ossified posterior longitudinal ligament.…”

Section: Discussionmentioning

confidence: 99%

“…They also investigated how common surgical techniques release the stress on the cord. 106 While the model was anatomically correct, it was not rotated to mimic physiologic motion. This is a major drawback as it has been reported that cervical myelopathy is dynamic and often worsens during neck movement.…”

Section: Discussionmentioning

confidence: 99%

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Surgical treatment for cervical myelopathy

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____________________________________________ Vincent Magnottaii To Grammy, Pop-Pop, and Mom who always stressed the importance of education, hard work, and helping others.And to Brigitta, the best sister there is.iii Genius is one percent inspiration, ninety-nine percent perspiration.-Thomas Edison I just try to help my people. -Rocco Santarelli III, age 4 iv ACKNOWLEDGEMENTS I could not have completed my graduate studies without the people mentioned here. Thank you all for supporting me through the journey. I first and foremost need to thank my adviser, Dr. Nicole Grosland. She has been the best adviser I could have hoped for. She has always been available and happy to give guidance I needed. Most importantly she's taught me not to be afraid to ask questions and realize when my FE models are good enough; perfection is not the goal, answering the research question is! I also need to thank my committee member, Dr. Vincent Magnotta, who was always willing to teach and help me understand the intricacies of MR imaging, and help me with all of my coding errors! I would also like to thank Dr. Matthew Howard and Dr. Kingsley Abode-Iyamah for all of their clinical input in this project. Being able to interact directly with you, the surgeons, and patients in the neurosurgery clinic has been invaluable to my education. Thank you to Dr. Nicole Kallemeyn and Dr. David Wilder for being on my committee and always asking interesting and thought provoking questions. Dr. Nicole Watson also deserves a big thank you for all of her patience and help with my finite element models. You're the best office-mate I could ask for! Thanks to Lisa and Jenny at CCAD for always making things run smoothly! Thank you to all of the good friends I've made over the last four years. Relaxing and having fun together has made this time wonderful. Finally I need to thank my family, especially my mother and sister, for always supporting and loving me unconditionally. v ABSTRACT Cervical myelopathy is the most common form of spinal cord injury in North America with roughly 19,000 new cases in the US every year. It results from chronic compression of the spinal cord by osteophytes, intervertebral disc herniation, and ossified ligaments. It commonly affects adults over the age of 50 years and causes upper extremity numbness, loss of hand dexterity, gait disturbances, and decreased proprioception. Recent studies imaging studies have shown this injury is highly

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Section: Discussioncontrasting

confidence: 66%

Section: Discussionmentioning

confidence: 99%

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Surgical treatment for cervical myelopathy

Stoner¹

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“…Posterior laminectomy with wide opening of the foraminal space would be favorable in this particular case, allowing decompression away from the offending pathology including osteophytes, ligaments, and discs. This would, however, require fusion which is usually achieved through posterior LMS fixation systems[ 29 ] [ Table 1 ].…”

Section: Discussionmentioning

confidence: 99%

Multilevel cervical laminectomy and fusion with posterior cervical cages

Monsef

Siemionow

2017

J Craniovert Jun Spine

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Context:Cervical spondylotic myelopathy (CSM) is a progressive disease that can result in significant disability. Single-level stenosis can be effectively decompressed through either anterior or posterior techniques. However, multilevel pathology can be challenging, especially in the presence of significant spinal stenosis. Three-level anterior decompression and fusion are associated with higher nonunion rates and prolonged dysphagia. Posterior multilevel laminectomies with foraminotomies jeopardize the bone stock required for stable fixation with lateral mass screws (LMSs).Aims:This is the first case series of multilevel laminectomy and fusion for CSM instrumented with posterior cervical cages.Settings and Design:Three patients presented with a history of worsening neck pain, numbness in bilateral upper extremities and gait disturbance, and examination findings consistent with myeloradiculopathy. Cervical magnetic resonance imaging demonstrated multilevel spondylosis resulting in moderate to severe bilateral foraminal stenosis at three cervical levels.Materials and Methods:The patients underwent a multilevel posterior cervical laminectomy and instrumented fusion with intervertebral cages placed between bilateral facet joints over three levels. Oswestry disability index and visual analog scores were collected preoperatively and at each follow-up. Pre- and post-operative images were analyzed for changes in cervical alignment and presence of arthrodesis.Results:Postoperatively, all patients showed marked improvement in neurological symptoms and neck pain. They had full resolution of radicular symptoms by 6 weeks postoperatively. At 12-month follow-up, they demonstrated solid arthrodesis on X-rays and computed tomography scan.Conclusions:Posterior cervical cages may be an alternative option to LMSs in multilevel cervical laminectomy and fusion for cervical spondylotic myeloradiculopathy.

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“…14,[25][26][27][28] In our previous study, an FE model of the cervical spine with the spinal cord, including white matter, gray matter, dura mater with nerve roots, denticulate ligaments, and cerebrospinal fluid (CSF), was developed and investigated the effect of surgical extents in three different decompression methods on changes in stress, strain, and posterior shift of the spinal cord for cervical OPLL. 29 However, few studies have focused on predicting stresses and strains in the spinal cord with the cervical OPLL under different neck positions before and after surgical intervention. In this study, the biomechanical parameters (von-Mises stress, maximum principal strain, and CSA) in the spinal cord under the flexion, neutral, and extension positions in cervical OPLL were then investigated for pre-operative and laminectomy models of the cervical spine, using the previously developed FE model of the cervical spine with the spinal cord.…”

Section: Introductionmentioning

confidence: 99%

Increased stress and strain on the spinal cord due to ossification of the posterior longitudinal ligament in the cervical spine under flexion after laminectomy

Khuyagbaatar

Kim

Park

et al. 2017

Proc Inst Mech Eng H

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Myelopathy in the cervical spine due to cervical ossification of the posterior longitudinal ligament could be induced by static compression and/or dynamic factors. It has been suggested that dynamic factors need to be considered when planning and performing the decompression surgery on patients with the ossification of the posterior longitudinal ligament. A finite element model of the C2-C7 cervical spine in the neutral position was developed and used to generate flexion and extension of the cervical spine. The segmental ossification of the posterior longitudinal ligament on the C5 was assumed, and laminectomy was performed on C4-C6 according to a conventional surgical technique. For various occupying ratios of the ossified ligament between 20% and 60%, von-Mises stresses, maximum principal strains in the spinal cord, and cross-sectional area of the cord were investigated in the pre-operative and laminectomy models under flexion, neutral position, and extension. The results were consistent with previous experimental and computational studies in terms of stress, strain, and cross-sectional area. Flexion leads to higher stresses and strains in the cord than the neutral position and extension, even after decompression surgery. These higher stresses and strains might be generated by residual compression occurring at the segment with the ossification of the posterior longitudinal ligament. This study provides fundamental information under different neck positions regarding biomechanical characteristics of the spinal cord in cervical ossification of the posterior longitudinal ligament.

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Effect of posterior decompression extent on biomechanical parameters of the spinal cord in cervical ossification of the posterior longitudinal ligament

Cited by 13 publications

References 48 publications

Surgical treatment for cervical myelopathy

Surgical treatment for cervical myelopathy

Multilevel cervical laminectomy and fusion with posterior cervical cages

Increased stress and strain on the spinal cord due to ossification of the posterior longitudinal ligament in the cervical spine under flexion after laminectomy

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