Biomechanical analysis of laminectomy, laminoplasty, posterior decompression with instrumented fusion, and anterior decompression with fusion for the kyphotic cervical spine.

Purpose: Anterior and posterior decompressions for cervical myelopathy and radiculopathy may lead to clinical improvements. However, patients with kyphotic cervical alignment have sometimes shown poor clinical outcomes with posterior decompression. There is a lack on report of mechanical analysis of the decompression procedures for kyphotic cervical alignment.

Methods: This study employed a three-dimensional finite element (FE) model of the cervical spine (C2-C7) with the pre-operative kyphotic alignment (Pre-OK) model and compared the biomechanical parameters (range of motion (ROM), annular stresses, nucleus stresses, and facet contact forces) for four decompression procedures at two levels (C3-C5); laminectomy (LN), laminoplasty (LP), posterior decompression with fusion (PDF), and anterior decompression with fusion (ADF). Pure moment with compressive follower load was applied to these models.

Results: PDF and ADF models' global ROM were 40% at C2-C7 less than the Pre-OK, LN, and LP models. The annular and nucleus stresses decreased more than 10% at the surgery levels for ADF, and PDF, compared to the Pre-OK, LN, and LP models. However, the annular stresses at the adjacent cranial level (C2-C3) of ADF were 20% higher. The nucleus stresses of the caudal adjacent level (C5-C6) of PDF were 20% higher, compared to other models. The PDF and ADF models showed a less than 70% decrease in the facet forces at the surgery levels, compared to the Pre-OK, LN, and LP models.

Conclusion: The study concluded that posterior decompression, such as LN or LP, increases ROM, disc stress, and facet force and thus can lead to instability. Although there is the risk of adjacent segment disease (ASD), PDF and ADF can stabilize the cervical spine even for kyphotic alignments.