Abstract:Background
Transforaminal full endoscopic lateral recess decompression (TE-LRD) can decompress lateral recess stenosis transforaminally under the endoscopy procedure. However, the biomechanical effects of the TE-LRD compared to the conventional decompression techniques are not reported. The purpose of this study is to compare the biomechanical effects of TE-LRD with conventional decompression techniques using finite element method.
Methods
Three finite element models of… Show more
“…[ 10 ] and was very close to the results of the FE study carried out by Matsumotoet et al . [ 9 ]. The validation results of the intact L4/5 model are shown in Fig.…”
Section: Resultsmentioning
confidence: 99%
“… Fig. 4 Comparison of the ROM data in the intact L4–L5 spinal model and experimental data from Panjabi et al [ 10 ] and finite element data from Matsumoto et al [ 9 ].2 …”
Section: Resultsmentioning
confidence: 99%
“…[ 10 ] and a FE study conducted by Matsumoto et al . [ 9 ]. For each of the ALIF and OLIF models, the inferior endplate of L5 was totally constrained.…”
Section: Methodsmentioning
confidence: 99%
“…For the intact L4/5 model, the inferior endplate of L5 was fixed at 6 degrees of freedom, and 10 Nm of pure moment was applied to the superior endplate of L4 to simulate flexion, extension, lateral bending, and rotation. The L4/5 segmental ranges of motion (ROMs) were compared with data of a cadaver study carried out by Panjabi et al [10] and a FE study conducted by Matsumoto et al [9]. For each of the ALIF and OLIF models, the inferior endplate of L5 was totally constrained.…”
Section: Boundary and Loading Conditionsmentioning
Background and objective
Anterior lumbar interbody fusion (ALIF) and oblique lumbar interbody fusion (OLIF) have shown a great surgical potential, while it has always been controversial which surgical approach and which type of fixation system should be selected. This study investigated the biomechanical response of ALIF and OLIF with various supplementary fixation systems using the finite element method.
Materials and methods
Lumbar L4–L5 ALIF and OLIF models stabilized by different supplementary fixation systems (stand-alone cage, integrated stand-alone cage, anterior plate, and bilateral pedicle screw) were developed to assess the segmental range of motion (ROM), endplate stress (EPS), and screw-bone interface stress (SBIS).
Experimental results
ALIF showed lower ROM and EPS than OLIF in all motion planes and less SBIS in the most of motion planes compared with OLIF when the anterior plate or pedicle screw was used. ALIF induced higher ROM, while lower EPS and SBIS than OLIF in the majority of motion planes when integrated stand-alone cage was utilized. Using a stand-alone cage in ALIF and OLIF led to cage migration. Integrated stand-alone cage prevented the cage migration, whereas caused significantly larger ROM, EPS, and SBIS than other fixation systems except for the rotation plane. In the most of motion planes, the pedicle screw had the lowest ROM, EPS, and SBIS. The anterior plate induced a slightly larger ROM, EPS, and SBIS than the pedicle screw, while the differences were not significant.
Conclusion
ALIF exhibited a better performance in postoperative segmental stability, endplate stress, and screw-bone interface stress than OLIF when the anterior plate or the pedicle screw was used. The pedicle screw could provide the greatest postoperative segmental stability, less cage subsidence incidence, and lower risk of fixation system loosening in ALIF and OLIF. The anterior plate could also contribute to the stability required and fewer complications, while not as effectively as the pedicle screw. Extreme caution should be regarded when the stand-alone cage is used due to the risk of cage migration. The integrated stand-alone cage may be an alternative method; however, further optimization is needed to reduce complications and improve postoperative segmental stability.
“…[ 10 ] and was very close to the results of the FE study carried out by Matsumotoet et al . [ 9 ]. The validation results of the intact L4/5 model are shown in Fig.…”
Section: Resultsmentioning
confidence: 99%
“… Fig. 4 Comparison of the ROM data in the intact L4–L5 spinal model and experimental data from Panjabi et al [ 10 ] and finite element data from Matsumoto et al [ 9 ].2 …”
Section: Resultsmentioning
confidence: 99%
“…[ 10 ] and a FE study conducted by Matsumoto et al . [ 9 ]. For each of the ALIF and OLIF models, the inferior endplate of L5 was totally constrained.…”
Section: Methodsmentioning
confidence: 99%
“…For the intact L4/5 model, the inferior endplate of L5 was fixed at 6 degrees of freedom, and 10 Nm of pure moment was applied to the superior endplate of L4 to simulate flexion, extension, lateral bending, and rotation. The L4/5 segmental ranges of motion (ROMs) were compared with data of a cadaver study carried out by Panjabi et al [10] and a FE study conducted by Matsumoto et al [9]. For each of the ALIF and OLIF models, the inferior endplate of L5 was totally constrained.…”
Section: Boundary and Loading Conditionsmentioning
Background and objective
Anterior lumbar interbody fusion (ALIF) and oblique lumbar interbody fusion (OLIF) have shown a great surgical potential, while it has always been controversial which surgical approach and which type of fixation system should be selected. This study investigated the biomechanical response of ALIF and OLIF with various supplementary fixation systems using the finite element method.
Materials and methods
Lumbar L4–L5 ALIF and OLIF models stabilized by different supplementary fixation systems (stand-alone cage, integrated stand-alone cage, anterior plate, and bilateral pedicle screw) were developed to assess the segmental range of motion (ROM), endplate stress (EPS), and screw-bone interface stress (SBIS).
Experimental results
ALIF showed lower ROM and EPS than OLIF in all motion planes and less SBIS in the most of motion planes compared with OLIF when the anterior plate or pedicle screw was used. ALIF induced higher ROM, while lower EPS and SBIS than OLIF in the majority of motion planes when integrated stand-alone cage was utilized. Using a stand-alone cage in ALIF and OLIF led to cage migration. Integrated stand-alone cage prevented the cage migration, whereas caused significantly larger ROM, EPS, and SBIS than other fixation systems except for the rotation plane. In the most of motion planes, the pedicle screw had the lowest ROM, EPS, and SBIS. The anterior plate induced a slightly larger ROM, EPS, and SBIS than the pedicle screw, while the differences were not significant.
Conclusion
ALIF exhibited a better performance in postoperative segmental stability, endplate stress, and screw-bone interface stress than OLIF when the anterior plate or the pedicle screw was used. The pedicle screw could provide the greatest postoperative segmental stability, less cage subsidence incidence, and lower risk of fixation system loosening in ALIF and OLIF. The anterior plate could also contribute to the stability required and fewer complications, while not as effectively as the pedicle screw. Extreme caution should be regarded when the stand-alone cage is used due to the risk of cage migration. The integrated stand-alone cage may be an alternative method; however, further optimization is needed to reduce complications and improve postoperative segmental stability.
“…Therefore, the principle of minimal invasiveness involves the restriction of unnecessary intervention; moreover, the intervention should not be inadequate for invasive resection, decompression, reduction, and fixation. Resection of the facet joint and annulus fibrosus is unavoidable in most minimally invasive techniques [11][12][13] .…”
Background Open decompression and posterior interbody fusion are standard surgical interventions for multiple degenerative lumbosacral spondylosis (DLS). Despite their clinical efficacy, intraoperative and postoperative complications have led to the demand for a minimally invasive approach. A biportal endoscopic approach is an advanced minimally invasive surgical option.
Objective and Methods The data of two patients with multiple DLS who had undergone biportal endoscopic spine surgery (BESS) were retrospectively analyzed. Parameters such as the surgical difficulty, duration of operation, blood loss, length of hospital stay, and postoperative complications were reviewed. Pain and functionality were assessed using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI), respectively.
Results Both patients were female and aged 75 and 73 years, respectively; they complained of back pain, claudication, pain and weakness in the lower extremities, and gait disturbance. The symptoms lasted 5 and 8 years, respectively. The multilevel BESS approach was applied bilaterally. Dissection, laminofacetectomy, decompression, excision, cage insertion, and screw implantation were performed. The operation durations were 170 and 160 minutes with blood loss of 500 mL and 650 mL, respectively. Back pain, leg pain, and ODI scores significantly improved; no false joints or additional neurological deficits were noted on follow-up.
Conclusions The presented BESS technique is a minimally invasive treatment option for patients with multiple DLS, which typically requires a complicated surgical approach. Randomized controlled studies with larger sample sizes and longer follow-up periods are needed to verify the superiority of this operation.
Purpose Degenerative Lumbar Spondylolisthesis (DSL) is a common spinal pathology characterized by the anterior slippage of one vertebral body on another. DSL is caused mainly by degeneration of the intervertebral disc in the first place, with subsequent degeneration of the facet joints that end causing the slippage. As the disease evolves, stability is restored as a result of advanced degeneration and disc collapse. But while this natural evolution takes place, DSL may produce radicular symptoms by different mechanisms. To present a “module-based” approach for the surgical planning and execution of full-endoscopic foraminotomy in DSL, combined with case examples of the most common surgical scenarios. Methods We propose a “module-based surgery” using the standard endoscopic foraminotomy technique as a baseline. According to the patient’s clinical and imaging characteristics, several “modules” can be added. The resulting endoscopic surgery is a summation of the basic endoscopic foraminotomy plus all the additional required modules. ResultsSurgical modules description and case examples are provided. ConclusionTransforaminal lumbar endoscopic foraminotomy represents a minimally invasive technique to treat foraminal and combined foraminal-lateral recess stenosis. DSL and its multiple scenarios represent a challenge to the endoscopic surgeon. Module-based approach can help systematize and execute these demanding endoscopic procedures.
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