title: Morphometric effects of acute shortening of the spine: the kinking and the sliding of the cord, response of the spinal nerves.
abstract: Spinal shortening is performed for a wide spectrum of diseases. This study was designed to investigate the morphologic effects of shortening on the spinal cord, to enlighten the amount and direction of the sliding of the cord, the alteration of the angles of the roots, and to identify the appropriate laminectomy length. Total vertebrectomy of T12 was applied to ten sheep models after spinal instrumentation. Gradual shortening was applied to five sheep; then, the degree and direction of the sliding of the spinal cord and the angles of the adjacent roots were measured. On five other sheep, additional sagittal sectioning was performed via excision of the pedicles. Measurements were taken at different laminectomy lengths to record kinking of the spinal cord with gradual shortening. The mean sliding of the spinal cord was 9 mm cranially and 7.8 mm caudally. T11 spinal nerves became more vertical caudally, and T12 spinal nerves achieved an ascending position with gradual shortening. Both T11 and T12 spinal nerves were sharply bent in the foramen and on the pedicle of T13, respectively. In full-length shortening, the mean kink of the spine in the sagittal plane was 92.4 degrees for two levels of hemi-laminectomies, 24.6 degrees for complete laminectomy of T11 with hemilaminectomy of T13, and 20.2 degrees for two levels of complete laminectomies. The slippage of the cord is dominant in the earlier stages and kinking is dominant in later stages of shortening. Increasing the laminectomy length by only a half or one level prevents excessive kinking and compressions at the upper and lower margins of the laminectomy. In the later stages of shortening, the spinal nerves near the vertebrectomy site are at risk because of the sharp bending of the nerves. This study describes the mechanism of the sliding and kinking of the cord due to gradual shortening of the spine, which might be useful in spinal surgery procedures. It also states that it is possible to avoid excessive kinking by planning the appropriate technique of laminectomy style in full-length shortening.
authors.affiliation: 2nd Orthopedics and Trauma Clinic, Ankara Training and Research Hospital, 76 Sok. 9/4 Emek, 06510 Ankara, Turkey. balemdaroglu@yahoo.com.tr
authors.forename: Kadir Bahadir
authors.initials: KB
authors.lastname: Alemdaroğlu
authors.forename: Doğan
authors.initials: D
authors.lastname: Atlihan
authors.forename: Oğuzhan
authors.initials: O
authors.lastname: Cimen
authors.forename: Cem Yalin
authors.initials: CY
authors.lastname: Kilinç
authors.forename: Serkan
authors.initials: S
authors.lastname: Iltar
mesh_terms: D000818:Animals; D005260:Female; D007796:Laminectomy / Q000379:methods; D023421:Models, Animal; D019637:Orthopedic Procedures / Q000379:methods*; D012756:Sheep; D013116:Spinal Cord / Q000473:pathology / Q000503:physiopathology*; D013127:Spinal Nerves / Q000473:pathology / Q000503:physiopathology*; D013904:Thoracic Vertebrae / Q000473:pathology / Q000601:surgery*