J Korean Soc Spine Surg.  2008 Mar;15(1):31-37. 10.4184/jkss.2008.15.1.31.

Radiographic Changes of Adjacent Upper Segment Performed Short Segmental Lumbosacral Fusion: Does Total Laminectomy Influence Adjacent Upper Segmental Instability?

• Hwang DW
• Shin JH
• Kim BM
• Park YS
• Lee JH
• Kim EH

• KMID: 1482841
• DOI: http://doi.org/10.4184/jkss.2008.15.1.31

Abstract

STUDY DESIGN: Retrospective study.
OBJECTIVES
The purpose of this study was to compare factors that influence degenerative changes in patients undergoing total laminectomy and patients undergoing partial laminectomy. SUMMARY OF LITERATURE REVIEW: Lumbar or lumbosacral fusion with total or partial laminectomy may result in adjacent segment problems of the upper segment. However, the differences between the two procedures that may influence adjacent segment instability are still controversial.
MATERIALS AND METHODS
We evaluated 95 patients, followed up for at least 2 years, who had been treated with short level (at most 2 levels) posterior lumbar interbody fusion with pedicle fixation, secondary to spinal stenosis. Treatment procedures included total laminectomy (42 cases) and partial laminectomy (53 cases). We analyzed the preoperative status of the intervertebral discs (Thompson grade), difference of disc height, and difference between preoperative segmental sagittal angle and last follow-up sagittal angle. We excluded cases that required revision secondary to infection, nonunion, or hematoma formation. However, we included cases that required revision due to adjacent segmental problems during the follow-up period.
RESULTS
The mean age of the patients treated with total laminectomy was 59.0+/-10.9 years, and of the patients treated with partial laminectomy was 58.8+/-10.2 years. The preoperative Thompson grade showed no statistical difference. The difference in disc height and segmental sagittal angle between the preoperative and last follow-up examinations showed no statistical difference between the two groups.
CONCLUSIONS
There was no significant difference in the radiographic or clinical outcomes based on removal or preservation of posterior structures. Nevertheless, we need further follow-up to evaluate adjacent segment degeneration.

Keyword

Spinal fusion; Adjacent segment; Total laminectomy

MeSH Terms

Follow-Up Studies
Hematoma
Humans
Intervertebral Disc
Laminectomy
Retrospective Studies
Spinal Fusion
Spinal Stenosis

Figure

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  Fig. 1. Total laminectomy includes removal of entire corresponding lamina, superior aspect of subjacent lamina, each facet joint, ligamentum flavum of corresponding and upper level and upper adjacent inter-, supraspinous ligament (shaded portion).

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  Fig. 2. Partial laminectomy includes removal of inferior part of corresponding lamina, superior aspect of subjacent lamina, each facet joint, ligamentum flavum of corresponding level (shaded portion)

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  Fig. 3. Method for calculating vertebral body sagittal rotation, difference of segmental angle between flexion and extension(E。 -F®).

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  Fig. 4. Plain radiographs of 50 years male with spinal stenosis L4-5. On preoperative AP and lateral radiographs, L3-4 disc height was 12 mm, sagittal rotation was 10 degrees (A). Dynamic radigraphs 3 years follow up after total laminectomy. Follow up L3-4 disc height 12 mm and sagittal rotation 8 degrees were checked (B, C).

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  Fig. 5. Plain radiographs of 52 years female with spinal stenosis L4-5. On preoperative AP and lateral radiographs, L3-4 disc height was 14mm, sagittal rotation was 5 degree (A). Dynamic radigraphs 3 years follow up after partial laminectomy. Follow up L3-4 disc height 13 mm and sagittal rotation 9 degrees were checked (B, C).

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