The effect of bilateral laminotomy versus laminectomy on the motion and stiffness of the human lumbar spine: a biomechanical comparison

Spine (Phila Pa 1976). 2010 Sep 1;35(19):1789-93. doi: 10.1097/BRS.0b013e3181c9b8d6.


Study design: A cadaveric simulation model of the lumbar spine was used to study the intervertebral motion characteristics of the lumbar spine after bilateral laminotomy and facet-sparing laminectomy.

Objective: To assess differences in motion patterns and lumbar spine stiffness after bilateral laminotomy versus laminectomy.

Summary of background data: Spondylolisthesis after facet-sparing laminectomy has been reported with a frequency of 8% to 31%. Bilateral laminotomies have been shown to be effective in decompressing the spine, without resection of the posterior osteo-ligamentous complex. We hypothesize that bilateral laminotomies induce significantly less iatrogenic hypermobility and less stiffness reduction than a traditional facet-sparing laminectomy in the lumbar spine.

Methods: Six fresh frozen human cadaveric lumbar spines (L1-L5) were mounted into a spine motion simulator for testing. With physiologic follower preload, flexion/extension, lateral bending, and axial rotation moments were applied to the lumbar spine in 3 trials: (1) Intact lumbar spine-no surgery, (2) Lumbar spine after bilateral lumbar laminotomies at L2-L5, (3) Lumbar spine after full laminectomies at L2-L5. The lumbar spine kinematics were measured using a Vicon motion tracking system. Total and segmental range of motion and spine stiffness were recorded.

Results: In flexion/extension, bilateral laminotomies resulted in an average increase in L2-L5 range of flexion/extension motion of 14.3%, whereas a full laminectomy resulted in an increase of 32.0% (P<0.05). Analysis per level demonstrated roughly twofold increase in motion with laminectomy compared with bilateral laminotomies (P<0.05, at every treated level). Stiffness was decreased by an average of 11.8% after the 3-level-laminotomies and by 27.2% (P<0.05) after the 3-level-laminectomy.

Conclusion: These data demonstrate that bilateral laminotomies induce significantly less hypermobility and less stiffness reduction compared with a full laminectomy. The preservation of the central posterior osteo-ligamentous structures may provide a stabilizing effect in preventing postdecompression spondylolisthesis.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Biomechanical Phenomena
  • Cadaver
  • Decompression, Surgical / adverse effects
  • Decompression, Surgical / methods*
  • Humans
  • Joint Instability / etiology
  • Joint Instability / physiopathology
  • Joint Instability / prevention & control
  • Laminectomy / adverse effects
  • Laminectomy / methods*
  • Lumbar Vertebrae / physiopathology
  • Lumbar Vertebrae / surgery*
  • Range of Motion, Articular
  • Spondylolisthesis / etiology
  • Spondylolisthesis / physiopathology
  • Spondylolisthesis / prevention & control