Abstract
BackgroundThe electrical properties of biological tissues differ depending on their physical properties. This study aimed to explore if bioelectrical impedance (modulus and phase) would discriminate tissues relevant to resection of the posterior longitudinal ligament (PLL) in anterior cervical decompression surgery.MethodsPLL resection via an anterior approach was performed on the C4/5 segments in six mini-pigs. The bioelectrical impedance measurements were performed for two tissue groups (annulus fibrosus, endplate cartilage, sub-endplate cortical bone, and PLL; PLL, dura mater, spinal cord, and nerve root) using a novel probe and a precision inductance-capacitance-resistance meter. For each group, impedance was analyzed in terms of modulus and phase along a broad spectrum of frequencies (200–3000 kHz) using a nonparametric statistical analysis (Kruskal-Wallis).ResultsThe analysis showed a clear difference among the tissues. The modulus and phase show the same changing trend with frequency and present lower values at higher frequencies. Among annulus fibrosus, endplate cartilage, sub-endplate cortical bone, and PLL, it was possible to discriminate each tissue at every frequency point, considering the phase (p < 0.05), while this was not always the case (i.e., annulus fibrosus vs PLL at frequency of 200 kHz, 400 kHz, and 3000 kHz, p > 0.05) for modulus. Among PLL, dura mater, spinal cord, and nerve root, for every comparison, a statistically significant difference was reported in the modulus, phase, or both (p < 0.05).ConclusionsThe results indicated the potential of bioelectrical impedance to provide real-time tissue differentiation and enhance safe PLL resection in anterior cervical decompression surgery, particularly in robot-assisted minimally invasive surgery (RMIS).
Highlights
The electrical properties of biological tissues differ depending on their physical properties
Disc removal followed by posterior longitudinal ligament (PLL) resection has been advocated for removing the hypertrophic PLL and achieving an increase in diameter of the spinal cord during anterior decompression in the cervical spine [7,8,9]
PLL resection is a technical challenge owing to the potential risks of complications such as dual defects, cerebrospinal fluid leakage, and injury to the spinal cord or nerve root [10,11,12,13]
Summary
The electrical properties of biological tissues differ depending on their physical properties. This study aimed to explore if bioelectrical impedance (modulus and phase) would discriminate tissues relevant to resection of the posterior longitudinal ligament (PLL) in anterior cervical decompression surgery. Anterior cervical decompression is one of the most common surgical procedures adopted in the treatment of CSM [5, 6]. Disc removal followed by posterior longitudinal ligament (PLL) resection has been advocated for removing the hypertrophic PLL and achieving an increase in diameter of the spinal cord during anterior decompression in the cervical spine [7,8,9]. Tissue discrimination by impedance would provide real-time values and offer a simple auxiliary feedback system for PLL resection in anterior cervical decompression surgery, in robot-assisted minimally invasive anterior cervical discectomy and fusion (ACDF) surgery
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