Abstract
ObjectiveTo evaluate the biomechanical influence after percutaneous endoscopic lumbar facetectomy in different diameters on segmental range of motion (ROM) and intradiscal pressure (IDP) of the relevant segments by establishing three dimensional finite element (FE) model.MethodsAn intact L3–5 model was successfully constructed from the CT of a healthy volunteer as Model A (MA). The Model B (MB), Model C (MC) and Model D (MD) were obtained through facetectomy on L4 inferior facet in diameters 7.5 mm, 10 mm and 15 mm on MA for simulation. The ROM and IDP of L3/4 and L4/5 of four models were all compared in forward flexion, backward extension, left and right bending, left and right rotation.ResultsCompared with MA, the ROM of L4/5 of MB, MC and MD all increased. MD changed more significantly than MB and MC in backward extension, right bending and right rotation. But that of MB and MC on L3/4 had no prominent change, while MD had a slight increase in backward extension. The IDP of MB and MC on L4/5 in six states was similar to MA, yet MD increased obviously in backward extension, right bending, left and right rotation. The IDP on L3/4 of MB and MC was resemble to MA in six conditions, nevertheless MD increased slightly only in backward extension.ConclusionCompared with the facetectomy in diameters 7.5 mm and 10 mm, the mechanical effect brought by facetectomy in diameter 15 mm on the operating segment changed more significantly, and had a corresponding effect on the adjacent segments.
Highlights
Lumbar disc herniation (LDH) and lumbar spinal stenosis (LSS) are common etiologies for spine surgery
Compared with the facetectomy in diameters 7.5 mm and 10 mm, the mechanical effect brought by facetectomy in diameter 15 mm on the operating segment changed more significantly, and had a corresponding effect on the adjacent segments
The results suggested that when the diameter of facetectomy on L4 is greater than a certain value, it may begin to have a corresponding effect on the intervertebral disc stress of the adjacent segments, and this effect may accelerate the degeneration of the adjacent segments
Summary
Lumbar disc herniation (LDH) and lumbar spinal stenosis (LSS) are common etiologies for spine surgery. Radialgia and numbness of lower extremity are frequent clinical symptoms, which seriously affect the life quality of patients [1, 2]. Open microdiscetomy is considered to be the gold standard method [4], the need for minimally invasive techniques and the improvements in the use of optics and surgical instruments have led to the utilization of PEID/PELD(PELD, Percutaneous Endoscopic Lumbar Discectomy; PEID, Percutaneous Endoscopic Interlaminar Discectomy). PEID and PELD, by virtue of its transforaminal approach, have several advantages over traditional open operations such as smaller wound, less blood loss, shorter hospital stays and hospitalization expenses, more rapid recovery, lower complication rate and infection rate [5]. With the promotion of lumbar percutaneous endoscopic instruments and the improvement of the technical level of clinicians, its indications are expanding
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