Individualized finite element simulation integrating high-resolution magnetic resonance imaging and clinical imaging validation elucidates the effects of laminoplasty and laminectomy on postoperative mechanical stability and degeneration risk.

INTRODUCTION: Posterior cervical decompression is widely used to relieve spinal cord compression; however, postoperative spinal stability and the risk of adjacent segment degeneration (ASD) remain important clinical concerns. Laminoplasty and laminectomy are the two principal posterior decompression procedures and differ substantially in their biomechanical consequences, yet systematic quantitative comparisons are still limited.

METHODS: In this study, an individualized three-dimensional finite element (FE) model integrating high-resolution magnetic resonance imaging (MRI) and computed tomography (CT) data was developed to compare these two procedures with respect to postoperative stability, load redistribution, adjacent-segment biomechanical risk, and fixation-related mechanical response. Quasi-static simulations of cervical motion were combined with postoperative MRI evaluation and clinical follow-up data for validation.

RESULTS: The results showed that laminoplasty was more effective than laminectomy in limiting postoperative increases in cervical mobility, reducing intradiscal pressure (IDP), and alleviating facet joint stress, thereby lowering the biomechanical risk of ASD. In addition, an imaging-mechanics coupled degeneration scoring system showed good predictive performance (area under the curve [AUC] = 0.87).

DISCUSSION: These findings clarify the biomechanical mechanisms by which different surgical strategies shape the postoperative mechanical environment and degeneration risk, and provide a quantitative framework to support individualized surgical planning and precision medicine in cervical spine surgery.