Efficacy of lumbar decompression under large-channel spinal endoscope in elderly patients with segmental lumbar spinal stenosis

Background This study aimed to evaluate the effect of foraminoplasty using large-channel endoscopy during TESSYS on the biomechanics of the lumbar spine. Methods A complete lumbar spine model, M1, was built using 3D finite elements, and models M2 and M3 were constructed to simulate the intraoperative removal of the superior articular process of L5 using a trephine saw with diameters of 5 mm and 8.5 mm, respectively, and applying normal physiological loads on the different models to simulate six working conditions—anterior flexion, posterior extension, left-right lateral bending, and left-right rotation—to investigate the displacement and facet joint stress change of the surgical segment, and the disc stress change of the surgical and adjacent segments. Results Compared with the M1 model, the M2 and M3 models showed decreased stress at the L4-5 left FJ and a significant increase in stress at the right FJ in forward flexion. In the M2 and M3 models, the L4-5 FJ stresses were significantly greater in left lateral bending or left rotation than in right lateral bending or right rotation. The right FJ stress in M3 was greater during left rotation than that in M2, and that in M2 was greater than that in M1. The L4-5disc stress in the M3 model was greater during posterior extension than that in the M1 and M2 models. The L4-5disc stress in the M3 model was greater in the right rotation than in the M2 model, and that in the M2 model was greater than that in the M1 model. Conclusion Foraminoplasty using large-channel endoscopy could increase the stress on the FJ and disc of the surgical segment, which suggested unnecessary and excessive resection should be avoided in PTED to minimize biomechanical disruption.

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The effect of large channel-based foraminoplasty on lumbar biomechanics in percutaneous endoscopic discectomy: a finite element analysis

Sun,

Li,

Zhang

et al. 2024

Preprint

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Background:The aim of this study was to evaluate the effect of arthroplasty using large-channel endoscopy during TESSYS on the biomechanics of the lumbar spine in patients. Methods:A complete lumbar spine model,M1, was built using 3D finite elements, and models M2 and M3 were built by simulating the intraoperative removal of the supra-articular synchondrosis of L5 using a Trephine saw withdiametersof 5 mm and 8.5 mm,respectively, and applying normal physiological loads on the different models to simulate six working conditions—lumbaranterior flexion, posterior extension, left-right lateral flexion, and left-right rotation—toobserve the stress distributions of the vertebral body, the discs, and the articular synchondrosis. Results: Compared with the M1 model, theM2 and M3 models showed a decrease in stress at the L4-5 left synaptic joint and a significant increase in stress at the right synaptic joint in forward flexion. In the M2 and M3 models, the L4-5 articular synaptic joint stresses were significantly greater in left lateral flexion or left rotation than in right lateral flexion or right rotation. The right synaptic joint stress in M3 was greater duringleft rotation than that in M2, and that in M2 was greater than that in M1. The L4-5 disc stress in the M3 model was greater duringposterior extension than that in the M1 and M2 models. The L4-5 disc stress in the M3 model was greater in the right rotation than in the M2 model, and that in the M2 model was greater than that in the M1 model. Conclusion:Arthroplasty using large-channel endoscopy increases the stress on articular synovial joints and segmental discs under certain working conditions but does not cause degeneration of the discs in adjacent segments.

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Efficacy of lumbar decompression under large-channel spinal endoscope in elderly patients with segmental lumbar spinal stenosis

Cited by 3 publications

References 20 publications

Effect of Different Interventions on Lumbar Spinal Stenosis: A Systematic Evaluation and Network Meta-Analysis

Effect of Different Interventions on Lumbar Spinal Stenosis: A Systematic Evaluation and Network Meta-Analysis

The effect of large channel-based foraminoplasty on lumbar biomechanics in percutaneous endoscopic discectomy: a finite element analysis

The effect of large channel-based foraminoplasty on lumbar biomechanics in percutaneous endoscopic discectomy: a finite element analysis

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