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Research Papers

Biomechanical Effects on Cervical Spinal Cord and Nerve Root Following Laminoplasty for Ossification of the Posterior Longitudinal Ligament in the Cervical Spine: A Comparison Between Open-Door and Double-Door Laminoplasty Using Finite Element Analysis

[+] Author and Article Information
Batbayar Khuyagbaatar

Department of Mechanical Engineering,
Kyung Hee University,
Yongin 17104, South Korea
e-mail: bayaraa_3d@yahoo.com

Kyungsoo Kim

Department of Applied Mathematics,
Kyung Hee University,
Yongin 17104, South Korea
e-mail: kyungsoo@khu.ac.kr

Tserenchimed Purevsuren

Department of Mechanical Engineering,
Kyung Hee University,
Yongin 17104, South Korea
e-mail: Tserenchimed.p@gmail.com

Sang-Hun Lee

Department of Orthopedic Surgery,
Johns Hopkins University,
Baltimore, MD 21287
e-mail: cspinelee@gmail.com

Yoon Hyuk Kim

Department of Mechanical Engineering,
Kyung Hee University,
Yongin 17104, South Korea
e-mail: yoonhkim@khu.ac.kr

1Corresponding author.

Manuscript received December 29, 2017; final manuscript received March 16, 2018; published online April 19, 2018. Assoc. Editor: Steven D. Abramowitch.

J Biomech Eng 140(7), 071006 (Apr 19, 2018) (7 pages) Paper No: BIO-17-1606; doi: 10.1115/1.4039826 History: Received December 29, 2017; Revised March 16, 2018

Many clinical case series have reported the predisposing factors for C5 palsy and have presented comparisons of the two types of laminoplasty. However, there have been no biomechanical studies focusing on cervical spinal cord and nerve root following laminoplasty. The purpose of this study is to investigate biomechanical changes in the spinal cord and nerve roots following the two most common types of laminoplasty, open-door and double-door laminoplasty, for cervical ossification of the posterior longitudinal ligament (OPLL). A finite element (FE) model of the cervical spine and spinal cord with nerve root complex structures was developed. Stress changes in the spinal cord and nerve roots, posterior shift of the spinal cord, and displacement of the cervical nerve roots were analyzed with two types of cervical laminoplasty models for variations in the degree of canal occupying ratio and shape of the OPLL. The shape and degree of spinal cord compression caused by the OPLL had more influence on the changes in stress, posterior shift of the spinal cord, and displacement of the nerve root than the type of laminoplasty. The lateral-type OPLL resulted in imbalanced stress on the nerve roots and the highest nerve root displacement. Type of laminoplasty and shape and degree of spinal cord compression caused by OPLL were found to influence the changes in stress and posterior displacement of the cervical spinal cord and nerve roots. Lateral-type OPLL might contribute to the development of C5 palsy due to the imbalanced stress and tension on the nerve roots after laminoplasty.

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References

Chiba, K. , Toyama, Y. , Matsumoto, M. , Maruiwa, H. , Watanabe, M. , and Hirabayashi, K. , 2002, “ Segmental Motor Paralysis After Expansive Open-Door Laminoplasty,” Spine, 27(19), pp. 2108–2115. [CrossRef] [PubMed]
Okada, M. , Minamide, A. , Endo, T. , Yoshida, M. , Kawakami, M. , Ando, M. , Hashizume, H. , Nakagawa, Y. , and Maio, K. , 2009, “ A Prospective Randomized Study of Clinical Outcomes in Patients With Cervical Compressive Myelopathy Treated With Open-Door or French-Door Laminoplasty,” Spine, 34(11), pp. 1119–1126. [CrossRef] [PubMed]
Kaneyama, S. , Sumi, M. , Kanatani, T. , Kasahara, K. , Kanemura, A. , Takabatake, M. , Nakatani, T. , and Yano, T. , 2010, “ Prospective Study and Multivariate Analysis of the Incidence of C5 Palsy After Cervical Laminoplasty,” Spine, 35(26), pp. E1553–1558. [CrossRef] [PubMed]
Hirabayashi, S. , Yamada, H. , Motosuneya, T. , Watanabe, Y. , Miura, M. , Sakai, H. , and Matsushita, T. , 2010, “ Comparison of Enlargement of the Spinal Canal After Cervical Laminoplasty: Open-Door Type and Double-Door Type,” Eur. Spine J., 19(10), pp. 1690–1694. [CrossRef] [PubMed]
Sakaura, H. , Hosono, N. , Mukai, Y. , Ishii, T. , and Yoshikawa, H. , 2003, “ C5 Palsy After Decompression Surgery for Cervical Myelopathy: Review of the Literature,” Spine, 28(21), pp. 2447–2451. [CrossRef] [PubMed]
Tsuzuki, N. , Abe, R. , Saiki, K. , and Zhongshi, L. , 1996, “ Extradural Tethering Effect as One Mechanisms of Radiculopathy Complicating Posterior Decompression of the Cervical Spinal Cord,” Spine, 21(2), pp. 203–211. [CrossRef] [PubMed]
Chen, Y. , Chen, D. , Wang, X. , Guo, Y. , and He, Z. , 2007, “ C5 Palsy After Laminectomy and Posterior Cervical Fixation for Ossification of Posterior Longitudinal Ligament,” J. Spinal Disord. Tech., 20(7), pp. 533–535. [CrossRef] [PubMed]
Imagama, S. , Matsuyama, Y. , Yukawa, Y. , Kawakami, N. , Kamiya, M. , Kanemura, T. , Ishiguro, N. , and Nagoya, S. G. , 2010, “ C5 Palsy After Cervical Laminoplasty: A Multicentre Study,” J. Bone Jt. Surg. Br., 92(3), pp. 393–400. [CrossRef]
Greaves, C. Y. , Gadala, M. S. , and Oxland, T. R. , 2008, “ A Three-Dimensional Finite Element Model of the Cervical Spine With Spinal Cord: An Investigation of Three Injury Mechanisms,” Ann. Biomed. Eng., 36(3), pp. 396–405. [CrossRef] [PubMed]
Russell, C. M. , Choo, A. M. , Tetzlaff, W. , Chung, T. E. , and Oxland, T. R. , 2012, “ Maximum Principal Strain Correlates With Spinal Cord Tissue Damage in Contusion and Dislocation Injuries in the Rat Cervical Spine,” J. Neurotrauma, 29(8), pp. 1574–1585. [CrossRef] [PubMed]
Scifert, J. , Totoribe, K. , Goel, V. , and Huntzinger, J. , 2002, “ Spinal Cord Mechanics During Flexion and Extension of the Cervical Spine: A Finite Element Study,” Pain Physician, 5(4), pp. 394–400. [PubMed]
Kato, Y. , Kanchiku, T. , Imajo, Y. , Kimura, K. , Ichihara, K. , Kawano, S. , Hamanaka, D. , Yaji, K. , and Taguchi, T. , 2010, “ Biomechanical Study of the Effect of Degree of Static Compression of the Spinal Cord in Ossification of the Posterior Longitudinal Ligament,” J. Neurosurg. Spine, 12(3), pp. 301–305. [CrossRef] [PubMed]
Khuyagbaatar, B. , Kim, K. , Park, W. M. , and Kim, Y. H. , 2015, “ Influence of Sagittal and Axial Types of Ossification of Posterior Longitudinal Ligament on Mechanical Stress in Cervical Spinal Cord: A Finite Element Analysis,” Clin. Biomech., 30(10), pp. 1133–1139. [CrossRef]
Persson, C. , Summers, J. , and Hall, R. M. , 2011, “ The Importance of Fluid-Structure Interaction in Spinal Trauma Models,” J. Neurotrauma, 28(1), pp. 113–125. [CrossRef] [PubMed]
Khuyagbaatar, B. , Kim, K. , and Kim, Y. H. , 2015, “ Conversion Equation Between the Drop Height in the New York Impactor and the Impact Force in the Infinite Horizon Impactor in the Contusion Spinal Cord Injury Model,” J. Neurotrauma, 32(24), pp. 1987–1993. [CrossRef] [PubMed]
Khuyagbaatar, B. , Kim, K. , Park, W. M. , and Kim, Y. H. , 2017, “ Biomechanical Investigation of Post-Operative C5 Palsy Due to Ossification of the Posterior Longitudinal Ligament in Different Types of Cervical Spinal Alignment,” J. Biomech., 57, pp. 54–61. [CrossRef] [PubMed]
Khuyagbaatar, B. , Kim, K. , Park, W. M. , and Kim, Y. H. , 2017, “ Biomechanical Behaviors in Three Types of Spinal Cord Injury Mechanisms,” ASME J. Biomech. Eng., 138(8), p. 081003. [CrossRef]
Kameyama, T. , Hashizume, Y. , and Sobue, G. , 1996, “ Morphologic Features of the Normal Human Cadaveric Spinal Cord,” Spine, 21(11), pp. 1285–1290. [CrossRef] [PubMed]
Alleyne , C. H., Jr., Cawley , C. M. , Barrow, D. L. , and Bonner, G. D. , 1998, “ Microsurgical Anatomy of the Dorsal Cervical Nerve Roots and the Cervical Dorsal Root Ganglion/Ventral Root Complexes,” Surg. Neurol., 50(3), pp. 213–218. [CrossRef] [PubMed]
Lohman, C. M. , Gilbert, K. K. , Sobczak, S. , Brismée, J. M. , James, C. R. , Day, M. , Smith, M. P. , Taylor, L. , Dugailly, P. M. , Pendergrass, T. , and Sizer, P. J. , 2015, “ 2015 Young Investigator Award Winner: Cervical Nerve Root Displacement and Strain During Upper Limb Neural Tension Testing—Part 1: A Minimally Invasive Assessment in Unembalmed Cadavers,” Spine, 40(11), pp. 793–800. [CrossRef] [PubMed]
Ceylan, D. , Tatarli, N. , Abdullaev, T. , Seker, A. , Yildiz, S. D. , Keles, E. , Konya, D. , Bayri, Y. , Kilic, T. , and Cavdar, S. , 2012, “ The Denticulate Ligament: Anatomical Properties, Functional and Clinical Significance,” Acta Neurochir., 154(7), pp. 1229–1234. [CrossRef]
Persson, C. , Evans, S. , Marsh, R. , Summers, J. L. , and Hall, R. M. , 2010, “ Poisson's Ratio and Strain Rate Dependency of the Constitutive Behavior of Spinal Dura Mater,” Ann. Biomed. Eng., 38(3), pp. 975–983. [CrossRef] [PubMed]
Singh, A. , Lu, Y. , Chen, C. , and Cavanaugh, J. M. , 2006, “ Mechanical Properties of Spinal Nerve Roots Subjected to Tension at Different Strain Rates,” J. Biomech., 39(9), pp. 1669–1676. [CrossRef] [PubMed]
Polak, K. , Czyż, M. , Ścigała, K. , Jarmundowicz, W. , and Będziński, R. , 2014, “ Biomechanical Characteristics of the Porcine Denticulate Ligament in Different Vertebral Levels of the Cervical Spine-Preliminary Results of an Experimental Study,” J. Mech. Behav. Biomed. Mater., 34, pp. 165–170. [CrossRef] [PubMed]
Kubo, S. , Goel, V. K. , and Tajima, N. , 2002, “ The Biomechanical Effects of Multilevel Posterior Foraminotomy and Foraminotomy With Double Door Laminoplasty,” J. Spinal. Disord. Tech., 15(6), pp. 477–485. [CrossRef] [PubMed]
Kubo, S. , Goel, V. K. , Yang, S. J. , and Tajima, N. , 2003, “ Biomechanical Evaluation of Cervical Double-Door Laminoplasty Using Hydroxyapatite Spacer,” Spine, 28(3), pp. 227–234. [PubMed]
Matsunaga, S. , Nakamura, K. , Seichi, A. , Yokoyama, T. , Toh, S. , Ichimura, S. , Satomi, K. , Endo, K. , Yamamoto, K. , Kato, Y. , Ito, T. , Tokuhashi, Y. , Uchida, K. , Baba, H. , Kawahara, N. , Tomita, K. , Matsuyama, Y. , Ishiguro, N. , Iwasaki, M. , Yoshikawa, H. , Yonenobu, K. , Kawakami, M. , Yoshida, M. , Inoue, S. , Tani, T. , Kaneko, K. , Taguchi, T. , Imakiire, T. , and Komiya, S. , 2008, “ Radiographic Predictors for the Development of Myelopathy in Patients With Ossification of the Posterior Longitudinal Ligament: A Multicenter Cohort Study,” Spine, 33(24), pp. 2648–2650. [CrossRef] [PubMed]
Sodeyama, T. , Goto, S. , Mochizuki, M. , Takahashi, J. , and Moriya, H. , 1999, “ Effect of Decompression Enlargement Laminoplasty for Posterior Shifting of the Spinal Cord,” Spine, 24(15), pp. 1527–1531. [CrossRef] [PubMed]
Nakashima, H. , Kato, F. , Yukawa, Y. , Imagama, S. , Ito, K. , Machino, M. , and Ishiguro, N. , 2014, “ Comparative Effectiveness of Open-Door Laminoplasty Versus French-Door Laminoplasty in Cervical Compressive Myelopathy,” Spine, 39(8), pp. 642–647. [CrossRef] [PubMed]
Wang, L. , Wang, Y. , Yu, B. , Li, Z. , and Liu, X. , 2015, “ Open-Door Versus French-Door Laminoplasty for the Treatment of Cervical Multilevel Compressive Myelopathy,” J. Clin. Neurosci., 22(3), pp. 450–455. [CrossRef] [PubMed]
Koyanagi, I. , Iwasaki, Y. , Hida, K. , Imamura, H. , Fujimoto, S. , and Akino, M. , 2003, “ Acute Cervical Cord Injury Associated With Ossification of the Posterior Longitudinal Ligament,” J. Neurosurg., 53(4), pp. 887–892. [CrossRef]

Figures

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Fig. 6

Distribution of von-Mises stress in the spinal cord at a 60% occupying ratio for the different types OPLL in the pre-operative and laminoplasty models. The transverse cross section of the spinal cord and nerve roots were created through a consistent plane for both the spinal cord and nerve roots.

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Fig. 5

(a) von-Mises stress in the cord and (b) right and left nerve roots according to types of OPLL in the pre-operative and two laminoplasty models: (a) maximum stress in the cord and (b) maximum stress in the right and left nerve roots

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Fig. 4

(a) Posterior shift of the spinal cord and (b) displacement of the right and left nerve roots according to type of OPLL in the pre-operative and two laminoplasty models

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Fig. 3

(a) Contact shapes of OPLL were classified as central (plateau and beak shaped) or lateral-type and (b) the OPLL occupying ratio were 20–60%

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Fig. 2

FE models of open-door and double-door laminoplasty. The decompression extent was C3–C7 for both types of laminoplasty, where the continuous-type OPLL was placed through the C4–C6 vertebral bodies.

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Fig. 1

(a) FE model of the cervical spine and spinal cord, (b) axial view of the spinal cord at the C5 vertebrae, and (c) spinal cord model shows the inside of the dura mater

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