Biomechanical limitations of partial pediculectomy in endoscopic spine surgery

Calek, Anna-Katharina; Tsagkaris, Christos; Fasser, Marie-Rosa; Widmer, Jonas; Hagel, Vincent; Farshad, Mazda

doi:10.1016/j.spinee.2023.02.005

Cited by 2 publications

(6 citation statements)

References 32 publications

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“…Currently, no biomechanical studies are available to investigate the effect of transpedicular access on pedicle stability. For the transforaminal approach, the influence of pedicle reduction on axial compression resistance was recently studied 25 and showed a median loss of resistance force compared with the intact side of 49% (90% worst case) for all pedicle reduction groups combined (10%–50% pedicle cross-section) compared with 26% (63% worst case) for the transpedicular approach (8 and 6 mm drill diameter combined). Cortical bone has weaker tensile strength than compressive strength 35 .…”

Section: Discussionmentioning

confidence: 99%

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The Biomechanics of the Transpedicular Endoscopic Approach

Meisterhans,

Hagel,

Spirig

et al. 2023

Spine

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Study Design. Biomechanical cadaveric study. Objective. The goal of this study was to analyze the effects of an endoscopic transpedicular approach with different drill diameters (6 and 8 mm) to compare them with the intact native side. In addition, the influence of bone quality on the resistance of the pedicle was investigated. Summary of Background Data. Clinical studies have repeatedly highlighted the benefits of endoscopic transpedicular decompression for down-migrated lumbar disc herniations. However, the biomechanical effects on pedicle stability have not been studied up to now. Methods. Twenty-four vertebras originating from four fresh-frozen cadavers were tested under uniaxial compression load in a ramp-to-failure test: (1) the tunneled pedicle on one side, and (2) the native pedicle on the other side. Twelve lumbar vertebrae were assigned to a drill diameter of 6 mm and the other 12 to a diameter of 8 mm. Results. The median ratio of sustained force for the operated side compared to the intact contralateral side is equal to 74% (63–88) for both drill diameters combined. An 8 mm transpedicular approach recorded an axial resistance of 77% (60–88) compared to the intact contralateral side (P=0.002). A 6 mm approach resulted in an axial resistance of 72% (66–84) compared to the intact opposite side (P=0.01). No significant difference between the two different drill diameters was recorded (P=1). For all 3 subgroups (intact, 8 mm, 6 mm) the HU-values and the absolute resistance force showed significant correlations (intact: ρ=0.859; P<0.001; 8 mm: ρ=0.902; P<0.001; 6 mm: ρ=0.835; P<0.001). Conclusion. Transpedicular approach significantly reduces the axial resistance force of the pedicle, which may lead to pedicle fracture. Bone quality correlated positively with the absolute resistance force of the pedicle, whereas the influence of the drill hole diameter plays only a limited role.

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Section: Discussionmentioning

confidence: 99%

“…Cortical bone has weaker tensile strength than compressive strength 35 . Foraminoplasty reduces the superior cortex of the pedicle, which is in tension under axial compression 25 . In the transpedicular approach, the superior cortical portion of the pedicle remains intact, 12,13 allowing the pedicle to bear potentially higher axial loads.…”

Section: Discussionmentioning

confidence: 99%

The Biomechanics of the Transpedicular Endoscopic Approach

Meisterhans,

Hagel,

Spirig

et al. 2023

Spine

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“…Considering the disadvantages of dorsal fusion and the risk of destabilization of the segment by decompression and further advancing the degenerative cascade [12][13][14] , an interspinous vertebropexy was performed. Its principle is based on a ligamentous reinforcement of vertebral bodies using autografts, allografts, or synthetic grafts to restore stability after decompression surgery 15,16 .…”

Section: Case Reportsmentioning

confidence: 99%

“…Discussion W e report the first clinical experience with lumbar vertebropexy, a new surgical method based on the principle of ligamentous stabilization. Promising early clinical and radiologic results were obtained, based on a series of previous biomechanical investigations 10,15 .…”

Section: Postoperative Coursementioning

confidence: 99%

“…We have developed lumbar vertebropexy based on a previously published case of a fusion-free solution for dropped head syndrome (occipitopexy 24 ) and several previously reported biomechanical studies 10,15 . The goal of vertebropexy was to overcome the disadvantages of spinal fusion and provide a solution for situations where some additional stability is needed.…”

Section: Postoperative Coursementioning

confidence: 99%

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Vertebropexy as a Ligamentous Stabilization for Degenerative Low-Grade Spondylolisthesis

Farshad,

Fasser,

Widmer

et al. 2023

JBJS Case Connector

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Case: Three patients with low-grade spondylolisthesis were treated with vertebropexy, a new surgical technique that replaces rigid fusion with ligamentous stabilization. Clinical outcomes, functional radiographs, and magnetic resonance imaging were used to document the early clinical results of this biomechanically established and promising new surgical method. Conclusion: Vertebropexy may be a valuable alternative to rigid fusion in the treatment of low-grade degenerative spondylolisthesis.

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Biomechanical limitations of partial pediculectomy in endoscopic spine surgery

Cited by 2 publications

References 32 publications

The Biomechanics of the Transpedicular Endoscopic Approach

The Biomechanics of the Transpedicular Endoscopic Approach

Vertebropexy as a Ligamentous Stabilization for Degenerative Low-Grade Spondylolisthesis

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