J Korean Neurosurg Soc.  2021 Mar;64(2):229-237. 10.3340/jkns.2020.0175.

Comparison of Spinal Canal Expansion Following Cervical Laminoplasty Based on the Preoperative Lamina Angle : A Simulation Study

• Jung Jm
• Jahng AL
• Hyun SJ
• Kim KJ
• Jahng TA

• KMID: 2513853
• DOI: http://doi.org/10.3340/jkns.2020.0175

Abstract

Objective
: Expansion in the spinal canal area (SCA) after laminoplasty is one of the critical factors to relieve the preoperative symptoms. No previous study has compared the increases in SCA achieved by open-door laminoplasty (ODL) and double door laminoplasty (DDL) according to the preoperative lamina angle (LA). This study was designed to clarify the relationship between the laminoplasty opening angle (OA)/laminoplasty opening size (OS) and increases in the SCA following ODL and DDL according to the preoperative LA using a simulation model.
Methods
: The simulation model was constructed and validated by comparing the clinical data of 64 patients who had undergone C3–C6 laminoplasty (43 patients with ODL and 21 patients with DDL). SCA expansion was predicted with a verified simulation model at various preoperative LAs (from 28° to 32°) with different OAs (40° to 44°) and OSs (10 mm to 14 mm) recruited from patient data.
Results
: The constructed simulation model was validated by comparing clinical data and revealed a very high degree of correlation (r=0.935, p<0.001). In this validated model, at the same OA, the increase in SCA was higher following ODL than following DDL in the usual LA (p<0.05). At the same OS, the increase in SCA was slightly larger following DDL than following ODL, but the difference was not significant (p>0.05). The difference was significant when the preoperative LA was narrower or much wider.
Conclusion
: Based on clinical data, a simulation model was constructed and verified that could predict increases in the SCA following ODL and DDL. When applying this model, prediction in SCA increase using the OS parameter was more practical and compatible with clinical data. Both laminoplasties achieved enough SCA, and there was no significant difference between them in the usual range.

Keyword

Cervical vertebrae; Laminoplasty; Spinal canal; Mathematics

Figure

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  Fig. 1. Radiologic parameters used in the present study. The shaded area shows the increase in the spinal canal area achieved after laminoplasty. A : Open-door laminoplasty. B : Double-door laminoplasty. α indicates the preoperative lamina angle and β indicates the laminoplasty opening angle. OS : opening size.

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  Fig. 2. Images of the simulation model developed using the GeoGebra program (International GeoGebra Institute, Linz, Austria). The shaded area shows the increased area of the spinal canal achieved after laminoplasty. α indicates the preoperative lamina angle and β indicates the laminoplasty opening angle. OA : opening angle, OS : opening size.

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  Fig. 3. Increases in the spinal canal area after open-door and double-door laminoplasty according to the preoperative lamina angle under same opening angle.

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  Fig. 4. Increases in the spinal canal area after open-door and doubledoor laminoplasty according to the preoperative lamina angle under same opening size. The inserted figure shows a magnified view for preoperative lamina angles ranging from 28° to 32°.

Reference

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