Biomechanical advantages of percutaneous endoscopic lumbar discectomy for lumbar disc herniation

doi:10.3969/j.issn.2095-4344.2907

Abstract

Abstract:

BACKGROUND: There are many operative methods for lumbar disc herniation; all kinds of operations have advantages and disadvantages. The biomechanical study of spine by finite element analysis can guide the clinical work.

OBJECTIVE: To establish L₃_-₅ three-dimensional finite element model and analyze the effect of different surgical methods on the mechanics of the spine after discectomy.

METHODS: A 35-year-old volunteer with no history of lumbar disease was selected. Lumbar CT data were obtained to build a finite element model and verify the validity. Five models of L₃/L₅ spine were established, including L₃/L₅ normal spine model as the model I, small fenestration operation as a model II, microendoscopic discectomy as model III, percutaneous endoscopic lumbar discectomy as model IV, and facet removal operation as model V. Stress distribution of L₄/L₅ vertebrae, intervertebral disc, left and right articular cartilages and displacement of L₄ vertebrae were measured under seven loading conditions.

RESULTS AND CONCLUSION: (1) The three-dimensional finite element model was effective. Model was effective by analysis of variance. (2) The stress concentration was low and the lowest instability of model III and IV by paired comparison. Model IV had the least effect on vertebral body in L₄ vertebral body stress. Model III and IV had the least effect on vertebral stability in the displacement of L₄ vertebral body. (3) From load modes, the less stress was received by the intervertebral disc when the joint damaged small, and the model IV was the smallest. The left articular process cartilage, models III and IV both maintained joint integrity. Under the right and left rotation load of on the right side, the greater stress received when the joint on the surgical side maintained more complete, so model IV was larger. On the contrary, the bilateral tilted load was in contrast, and the model V was largest. L₄-vertebral had the smallest equivalent stress in model IV. The displacement was obvious when the joint damaged more. Models III and IV had the smallest displacements and were close to model I. (4) It is indicated that surgical model of percutaneous endoscopic lumbar discectomy has the smallest stress distribution in the vertebral body, intervertebral disc, and articular process, and has obvious advantages. The displacements of microendoscopic discectomy and percutaneous endoscopic lumbar discectomy are more stable than other surgical models. There is no difference between the two. Therefore, percutaneous endoscopic lumbar discectomy is currently an ideal technique.

Key words: bone, lumbar vertebrae, lumbar intervertebral disc, intervertebral foramen, nucleus pulposus, biomechanics, finite element analysis

CLC Number:

Tuerhongjiang·Abuduresiti, Meng Xiangyu, Maihemuti·Yakufu, Wang Tiantang, Xieraili·Maimaiti, Dai Jifang, Wang Wei. Biomechanical advantages of percutaneous endoscopic lumbar discectomy for lumbar disc herniation[J]. Chinese Journal of Tissue Engineering Research, 2020, 24(36): 5768-5773.

Figures/Tables 9

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