title: Transforaminal and posterior decompressions of the lumbar spine. A comparative study of stability and intervertebral foramen area.
abstract: METHODS
  Ten fresh, cadaveric, two-vertebrae, functional spinal units were used to study the pathoanatomy, intervertebral foraminal area, and flexibility changes after posterior and transforaminal decompression.
  
  
  OBJECTIVE
  To determine the feasibility of an endoscopic transforaminal approach as an alternative to conventional approaches, to establish the adequacy of transforaminal decompression without destabilizing the spine, and to study the structural changes in the spine after decompressions.
  
  
  BACKGROUND
  Posterior decompression entails major dissection and excision of bone and ligaments to access the spinal canal. Posterior decompression may be complicated by acute or chronic spinal instability, and the adequacy of lateral decompression is highly subjective.
  
  
  METHODS
  The functional spinal units were mounted in quick-setting epoxy blocks. Pre- and postoperative computed tomography scans were taken to study changes in the foraminal area. Pre- and postoperative flexibility and anatomic studies were performed to compare the results.
  
  
  RESULTS
  A 45.5% increase in the intervertebral foraminal area was possible, there was no flexibility change, and minimal anatomic damage to the spine was noted after transforaminal decompression. A 34.2% increase in the intervertebral foraminal area and a significant increase in extension and axial rotation flexibility were noted after the posterior decompression.
  
  
  CONCLUSIONS
  Transforaminal decompression produced a significantly larger increase in the intervertebral foraminal area than posterior decompression, without increasing the range of motion or neutral zone in any direction. Because there was no violation of the anatomic integrity of the spine in the transforaminal approach, the risk of surgically induced instability was minimized. Endoscopic transforaminal decompression is a feasible alternative to current approaches.
authors.affiliation: Department of Orthopaedics and Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: S G
authors.initials: SG
authors.lastname: Osman
authors.forename: K
authors.initials: K
authors.lastname: Nibu
authors.forename: M M
authors.initials: MM
authors.lastname: Panjabi
authors.forename: E B
authors.initials: EB
authors.lastname: Marsolais
authors.forename: R
authors.initials: R
authors.lastname: Chaudhary
mesh_terms: D000328:Adult; D000368:Aged; D002102:Cadaver; D004724:Endoscopy; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000473:pathology; D008159:Lumbar Vertebrae / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D013117:Spinal Cord Compression / Q000473:pathology*; D013130:Spinal Stenosis / Q000473:pathology*; D014057:Tomography, X-Ray Computed