Innocent U Njoku1, Joshua Young-Ki Park2, Mohammed A Munim2, Amelia Clarke2, Christina W Cheng3,2. 1. University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA Innocent.Njoku@Uhhospitals.org. 2. Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. 3. University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
Abstract
BACKGROUND: Lumbar laminectomy is a surgical procedure allowing for decompression of neural structures. A wide laminectomy to adequately decompress neural elements without compromising the structural integrity of the spinal column is ideal. Pars interarticularis fractures with spinal instability after isolated laminectomy from overresection of the posterior elements have been reported. There are limited anatomical studies in the spine literature that measure the pars interarticularis distance (PID) and spinal canal width (SCW) in the lumbar spine. OBJECTIVE: The purpose of this study was to assess the differences in PID and SCW at each level of the lumbar spine and to determine their effects on the extent of laminectomy at each lumbar level. METHODS: We performed an anatomic study measuring PID and SCW in the lumbar spine from 93 skeletally matured osseous specimens. Groups were compared using an independent sample t test, 1-way analysis of variance, and Wilcoxon test, and significance was set at P < 0.05. RESULTS: Our study suggests that the distance between PID and SCW increases from L1 to L5 in African American and Caucasian women and men. However, the respective increase in SCW at each lumbar level is less than the respective increase in PID at the same levels. This trend suggests that there is a wider window available for decompression without compromising spinal stability in the lower lumbar spine compared with the upper lumbar spine. CONCLUSIONS: Our findings suggest that the upper lumbar spine has a narrower window for decompression; therefore, care should be taken to preserve as much of the pars at L1-L3. Understanding the variations in PID and SCW in the lumbar spine will help surgeons perform adequate decompression of a stenotic canal while avoiding postoperative spinal instability. CLINICAL RELEVANCE: Awareness of PID to SCW ratio may help spine surgeons avoid iatrogenic instability, postoperative intractable back pain, spondylolisthesis, or complications involving alterations of the lumbar spine biomechanics. This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery.
BACKGROUND: Lumbar laminectomy is a surgical procedure allowing for decompression of neural structures. A wide laminectomy to adequately decompress neural elements without compromising the structural integrity of the spinal column is ideal. Pars interarticularis fractures with spinal instability after isolated laminectomy from overresection of the posterior elements have been reported. There are limited anatomical studies in the spine literature that measure the pars interarticularis distance (PID) and spinal canal width (SCW) in the lumbar spine. OBJECTIVE: The purpose of this study was to assess the differences in PID and SCW at each level of the lumbar spine and to determine their effects on the extent of laminectomy at each lumbar level. METHODS: We performed an anatomic study measuring PID and SCW in the lumbar spine from 93 skeletally matured osseous specimens. Groups were compared using an independent sample t test, 1-way analysis of variance, and Wilcoxon test, and significance was set at P < 0.05. RESULTS: Our study suggests that the distance between PID and SCW increases from L1 to L5 in African American and Caucasian women and men. However, the respective increase in SCW at each lumbar level is less than the respective increase in PID at the same levels. This trend suggests that there is a wider window available for decompression without compromising spinal stability in the lower lumbar spine compared with the upper lumbar spine. CONCLUSIONS: Our findings suggest that the upper lumbar spine has a narrower window for decompression; therefore, care should be taken to preserve as much of the pars at L1-L3. Understanding the variations in PID and SCW in the lumbar spine will help surgeons perform adequate decompression of a stenotic canal while avoiding postoperative spinal instability. CLINICAL RELEVANCE: Awareness of PID to SCW ratio may help spine surgeons avoid iatrogenic instability, postoperative intractable back pain, spondylolisthesis, or complications involving alterations of the lumbar spine biomechanics. This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery.