The London Spine Unit : most advanced spinal hospital in the world
Published article
CONCLUSION: Biomechanically, the transforaminal endoscopic intracanal technique preserves the native range of motion of lumbar vertebral segments and shows a trend towards biomechanically superiority to the inside-out technique and open decompression procedures.
Lumbar Decompression Surgery Expert. Best Spinal Surgeon UK
Spine (Phila Pa 1976). 2022 Sep 7. doi: 10.1097/BRS.0000000000004471. Online ahead of print.
ABSTRACT
STUDY DESIGN: Biomechanical cadaveric study.
OBJECTIVE: The aim of this study was to compare the effect of transforaminal endoscopic approaches with open decompression procedures.
SUMMARYOF BACKGROUND DATA: Clinical studies have repeatedly highlighted the benefits of endoscopic decompression, however, the biomechanical effects of endoscopic approaches (with and without injury to the disc) have not been studied up to now.
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: Vertebral segment ROM was comparable between the two endoscopic transforaminal approaches. However, there was a – statistically non-significant – 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 to 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: Biomechanically, the transforaminal endoscopic intracanal technique preserves the native range of motion of lumbar vertebral segments and shows a trend towards biomechanically superiority to the inside-out technique and open decompression procedures.
PMID:36083835 | DOI:10.1097/BRS.0000000000004471
The London Spine Unit : most advanced spinal hospital in the world
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