Abstract
Percutaneous endoscopic technology has been widely used in the treatment of lumbar disc stenosis and herniation. However, the quantitative influence of percutaneous endoscopic lumbar decompression on spinal biomechanics of the L5–S1 lumbosacral segment remains poorly understood. Hence, the objective of this study is to investigate the combined effects on the biomechanics of different grades of foraminotomy and annular defect for the L5–S1 segment. A 3D, nonlinear, detailed finite element model of L4–S1 was established and validated. Changes in biomechanical responses upon stimulation to the intact spine during different degrees of resection were analyzed. Measurements included intervertebral rotation, intradiscal pressure, and the strain of disc structure under flexion, extension, left/right lateral bending, and left/right axial rotation under pure bending moments and physiological loads. Compared with the intact model, under prefollower load, annular defect slightly decreased intervertebral rotation by −5.0% in extension and 2.2% in right axial rotation and significantly increased the mean strain of the exposed disc by 237.7% in all loading cases. For right axial rotation, unilateral total foraminotomy with an annular detect increased intervertebral rotation by 29.5% and intradiscal pressure by 57.6% under pure bending moment while the maximum corresponding values were 9.8% and 6.6% when the degree of foraminotomy was below 75%, respectively. These results indicate that percutaneous endoscopic lumbar foraminotomy highly maintains spinal stability, even if the effect of annular detect is taken into account, when the unilateral facet is not totally removed. Patients should avoid excessive extension and axial rotation after surgery on L5–S1. The postoperative open annular defect may substantially increase the risk of recurrent disc herniation.
Highlights
80% of all adults are affected by low back pain (LBP) during their daily lives [1]
Validation. e intervertebral rotation (IVR) response of the L5–S1 and L4–L5 motion segments was consistent with in vitro experimental measurements [33, 34], as shown in Figure 3. e nonlinearity relationship between the moment and rotation was accurately simulated in the lumbar spine
E predicted intradiscal pressure (IDP) of the L5–S1 and L4–L5 discs in response to the extension moment loading and compression force fell within the range of available experimental data [35, 36], respectively. e IDP increased linearly with the applied moment and axial compression loading (Figure 4)
Summary
80% of all adults are affected by low back pain (LBP) during their daily lives [1]. Lumbar spinal stenosis (LSS) is a common cause of LBP with leg pain and is often accompanied by lumbar disc herniation (LDH) [2]. E prevalent physiopathology of spinal stenosis is related to the compression of the nerve root by the herniated disc, hypertrophied facets, and ligamentum flavum [3]. Conventional open decompression surgical interventions are regarded as the gold standard treatment, minimally invasive technology has been widely. Percutaneous endoscopic decompression (PED) techniques are emerging minimally invasive alternative for treating LSS, which shows comparable clinical outcomes to the conventional open surgery with shorter operation times, lower levels of tissue trauma, and lower treatment costs [6, 7]. PED, including interlaminar PED, transforaminal PED, and percutaneous endoscopic lumbar foraminotomy (PELF), and the choice of the surgical method are primarily related to the type of LSS
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