Abstract
BackgroundPercutaneous transforaminal endoscopic discectomy (PTED) is widely used for the treatment of lumbar disc herniation. Facetectomy in PTED is necessary for accessing the intraspinal region and for decompressing the exiting nerve roots in patients who suffer from hypertrophy of the facet joints. However, this may increase morbidity in failed back surgery syndrome (FBSS) and has not been clearly elucidated.MethodsA three-dimensional lumbosacral model was reconstructed and validated. And corresponding models after PTED with one-quarter and one-half excisions of the superior articular process were reconstructed. The maximum shear stress on the annulus in L5, von Mises stress of the facet cartilage, maximum principle capsular strain and deformation of the lumbosacral model were calculated using finite element methods.ResultsCalculated results show no significant differences in the complete model and the model with one-quarter excision of the superior articular process, but all biomechanical indexes have been deteriorated under most of the loading conditions tested in the model with one-half excision of the superior articular process.ConclusionsLess facetectomy is better because it may reduce the risk of biomechanical deterioration and consequently, that of FBSS.
Highlights
Percutaneous transforaminal endoscopic discectomy (PTED) is widely used for the treatment of lumbar disc herniation
In patients who suffer from hypertrophy of the facet joints, extensive facetectomy is needed for the decompression of exiting nerve roots
Clinical studies have shown that minimally invasive surgical methods do not significantly decrease morbidity associated with postoperative complications compared to open surgery, and the damage to osteoligamentous structures during the microdiscectomy procedure can result in biomechanical deterioration [5, 37, 41]
Summary
Percutaneous transforaminal endoscopic discectomy (PTED) is widely used for the treatment of lumbar disc herniation. Facetectomy in PTED is necessary for accessing the intraspinal region and for decompressing the exiting nerve roots in patients who suffer from hypertrophy of the facet joints This may increase morbidity in failed back surgery syndrome (FBSS) and has not been clearly elucidated. In patients who suffer from hypertrophy of the facet joints, extensive facetectomy is needed for the decompression of exiting nerve roots Such a Aetiologies related to facet joints involved in the pathogenesis of low back pain (LBP) occur in 15–37% of patients after surgery [9, 10], .and injury to the facet joint has been reported to cause a series of postoperative complications [6, 11]. Rich innervation is a typical histological feature of the facet capsule, and any increase in the mobility of the
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