Increase of motion between lumbar vertebrae after excision of the capsule and cartilage of the facets. A cadaver study.
Seventeen fresh segments of cadaveric lumbar spines were tested in flexion, extension, and axial rotation. The resulting angular rotations were measured with the use of a goniometer and a three-dimensional system of video analysis. Measurements of flexibility were made, in order, in the intact spine; after decompression (bilateral total laminectomies, partial medial facetectomies, and foraminotomies); after excision of the capsule and cartilage of the facets; and after cancellous bone had been packed into the facet defects. Decompression resulted in a slight increase in the sagittal and axial ranges of motion. Subsequent excision of the capsule and cartilage of the facets, as in preparation for an arthrodesis of the facets, resulted in a significant increase in both the sagittal (5.7 +/- 2.9 degrees, mean and standard deviation) (p < 0.001) and the axial (1.4 +/- 0.9 degrees) (p < 0.01) ranges of motion compared with the motion in the intact specimen and with the motion in the specimen after only decompression had been done (p < 0.01 and p < 0.05, respectively). Packing of bone in the facets did not significantly reduce motion. It was calculated that the increase in the sagittal range of motion after excision of the capsule and cartilage of the facets would increase the tensile strain in a graft between the transverse processes of the fourth and fifth lumbar vertebrae (18 +/- 1 per cent tensile strain [mean and 95 per cent confidence interval] for the intact vertebrae and 25 +/- 1 per cent for the vertebrae in which the facets had been excised).
Boden
S D
SD
Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia.
Martin
C
C
Rudolph
R
R
Kirkpatrick
J S
JS
Moeini
S M
SM
Hutton
W C
WC
D001696:Biomechanical Phenomena; D016025:Bone Transplantation; D002358:Cartilage, Articular / Q000601:surgery*; D006801:Humans; D017746:Joint Capsule / Q000601:surgery*; D007796:Laminectomy; D008159:Lumbar Vertebrae / Q000502:physiology* / Q000601:surgery; D009068:Movement; D016059:Range of Motion, Articular; D013123:Spinal Fusion; D013718:Tensile Strength