Yonsei Med J.  2015 Jan;56(1):146-153. 10.3349/ymj.2015.56.1.146.

Finite Element Analysis for Comparison of Spinous Process Osteotomies Technique with Conventional Laminectomy as Lumbar Decompression Procedure

• Kim HJ
• Chun HJ
• Kang KT
• Lee HM
• Chang BS
• Lee CK
• Yeom JS

• KMID: 2352800
• DOI: http://doi.org/10.3349/ymj.2015.56.1.146

Abstract

PURPOSE
The purpose of this study was to evaluate and compare the biomechanical behavior of the lumbar spine after posterior decompression with the spinous process osteotomy (SPiO) technique or the conventional laminectomy (CL) technique using a finite element (FE) model.
MATERIALS AND METHODS
Three validated lumbar FE models (L2-5) which represented intact spine and two decompression models using SPiO and CL techniques at the L3-4 segment were developed. In each model, the ranges of motion, the maximal von Mises stress of the annulus fibrosus, and the intradiscal pressures at the index segment (L3-4) and adjacent segments (L2-3 and L4-5) under 7.5 Nm moments were analyzed. Facet contact forces were also compared among three models under the extension and torsion moments.
RESULTS
Compared to the intact model, the CL and SPiO models had increased range of motion and annulus stress at both the index segment (L3-4) and the adjacent segments under flexion and torsion. However, the SPiO model demonstrated a reduced range of motion and annulus stress than the CL model. Both CL and SPiO models had an increase of facet contact force at the L3-4 segment under the torsion moment compared to that of the intact model. Under the extension moment, however, three models demonstrated a similar facet contact force even at the L3-4 model.
CONCLUSION
Both decompression methods lead to postoperative segmental instability compared to the intact model. However, SPiO technique leads to better segmental stability compared to the CL technique.

Keyword

Lumbar spinal stenosis; spinous process osteotomies; conventional laminectomy; finite element model

MeSH Terms

Biomechanical Phenomena
Decompression, Surgical/*methods
*Finite Element Analysis
Humans
Intervertebral Disc/physiopathology/surgery
Laminectomy/*methods
Lumbar Vertebrae/pathology/physiopathology/*surgery
Male
Middle Aged
Models, Anatomic
Osteotomy/*methods
Range of Motion, Articular
Stress, Mechanical
Zygapophyseal Joint/pathology/physiopathology/surgery

Figure

• 

  Fig. 1 Finite element models. (A) Conventional laminectomy (CL) model; arrow indicates the sacrifice of posterior ligament complex. (B) Spinous process osteotomy (SPiO) model; arrow indicates the preservation of posterior ligament complex.

• 

  Fig. 2 Comparison between the three models of the range of motion at each segment for the four moments. CL, conventional laminectomy; SPiO, spinous process osteotomy.

• 

  Fig. 3 Comparison of the maximal von Mises stress of the annulus fibrosus and the intradiscal pressure of the nucleus pulposus among three models. (A) Comparison of the maximal von Mises stress of the annulus fibrosus (MPa). (B) Comparison of intradiscal pressure of the nucleus pulposus.

• 

  Fig. 4 Distribution of stress of the annulus fibrosus in the CL and SPiO models under flexion and torsion moment. (A) CL model under flexion. (B) SPiO model under flexion. (C) CL model under torsion. (D) SPiO model under torsion. CL, conventional laminectomy; SPiO, spinous process osteotomy.

• 

  Fig. 5 Comparison of the facet contact force among 3 models. CL, conventional laminectomy; SPiO, spinous process osteotomy.

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