Biomechanics of Transforaminal Endoscopic Approaches.
Journal
Spine
ISSN: 1528-1159
Titre abrégé: Spine (Phila Pa 1976)
Pays: United States
ID NLM: 7610646
Informations de publication
Date de publication:
15 Dec 2022
15 Dec 2022
Historique:
received:
03
06
2022
accepted:
16
08
2022
pubmed:
10
9
2022
medline:
1
12
2022
entrez:
9
9
2022
Statut:
ppublish
Résumé
Biomechanical cadaveric study. The aim of this study was to compare the effect of transforaminal endoscopic approaches with open decompression procedures. Clinical studies have repeatedly highlighted the benefits of endoscopic decompression, however, the biomechanical effects of endoscopic approaches (with and without injury to the disk) have not been studied up to now. Twelve spinal segments originating from four fresh-frozen cadavers were biomechanically tested in a load-controlled endoscopic transforaminal approach study. Segmental range of motion (ROM) after endoscopic approach was compared with segmental ROM after (1) microsurgical decompression with unilateral laminotomy and (2) midline decompression with bilateral laminotomy. In the intact state and after decompression, the segments were loaded in flexion-extension (FE), lateral shear (LS), lateral bending (LB), anterior shear (AS), and axial rotation (AR). Vertebral segment ROM was comparable between the two endoscopic transforaminal approaches. However, there was a-statistically nonsignificant-trend for a larger ROM after accessing via the inside-out technique: FE: +3% versus +7%, P =0.484; LS: +1% versus +12%, P =0.18; LB: +0.6% versus +9%, P =0.18; AS: +2% versus +11%, P =0.31; AR: -4% versus +5%, P =0.18. No significant difference in vertebral segment ROM was seen between the transforaminal endoscopic approaches and open unilateral decompression. Vertebral segment ROM was significantly smaller with the transforaminal endoscopic approaches compared with midline decompression for almost all loading scenarios: FE: +4% versus +17%, P =0.005; AS: +6% versus 21%, P =0.007; AR: 0% versus +24%, P =0.002. The transforaminal endoscopic intracanal technique preserves the native ROM of lumbar vertebral segments and shows a trend toward relative biomechanical superiority over the inside-out technique and open decompression procedures.
Sections du résumé
STUDY DESIGN
METHODS
Biomechanical cadaveric study.
OBJECTIVE
OBJECTIVE
The aim of this study was to compare the effect of transforaminal endoscopic approaches with open decompression procedures.
SUMMARY OF BACKGROUND DATA
BACKGROUND
Clinical studies have repeatedly highlighted the benefits of endoscopic decompression, however, the biomechanical effects of endoscopic approaches (with and without injury to the disk) have not been studied up to now.
MATERIALS AND METHODS
METHODS
Twelve spinal segments originating from four fresh-frozen cadavers were biomechanically tested in a load-controlled endoscopic transforaminal approach study. Segmental range of motion (ROM) after endoscopic approach was compared with segmental ROM after (1) microsurgical decompression with unilateral laminotomy and (2) midline decompression with bilateral laminotomy. In the intact state and after decompression, the segments were loaded in flexion-extension (FE), lateral shear (LS), lateral bending (LB), anterior shear (AS), and axial rotation (AR).
RESULTS
RESULTS
Vertebral segment ROM was comparable between the two endoscopic transforaminal approaches. However, there was a-statistically nonsignificant-trend for a larger ROM after accessing via the inside-out technique: FE: +3% versus +7%, P =0.484; LS: +1% versus +12%, P =0.18; LB: +0.6% versus +9%, P =0.18; AS: +2% versus +11%, P =0.31; AR: -4% versus +5%, P =0.18. No significant difference in vertebral segment ROM was seen between the transforaminal endoscopic approaches and open unilateral decompression. Vertebral segment ROM was significantly smaller with the transforaminal endoscopic approaches compared with midline decompression for almost all loading scenarios: FE: +4% versus +17%, P =0.005; AS: +6% versus 21%, P =0.007; AR: 0% versus +24%, P =0.002.
CONCLUSION
CONCLUSIONS
The transforaminal endoscopic intracanal technique preserves the native ROM of lumbar vertebral segments and shows a trend toward relative biomechanical superiority over the inside-out technique and open decompression procedures.
Identifiants
pubmed: 36083835
doi: 10.1097/BRS.0000000000004471
pii: 00007632-202212150-00009
pmc: PMC10010693
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1753-1760Informations de copyright
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors report no conflicts of interest.
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