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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Grahic Jump Location
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

Grahic Jump Location
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.

Grahic Jump Location
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%

Grahic Jump Location
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

Grahic Jump Location
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

Grahic Jump Location
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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