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Finite element mechanical analysis of ipsilateral approach and contralateral approach in unilateral bilateral endoscopic spine surgery – Lumbar Spinal Stenosis

The article discusses the use of unilateral bilateral endoscopic spine surgery (UBE) as a treatment for lumbar spinal stenosis and disc herniation. The study compares the ipsilateral approach and contralateral approach of UBE in terms of their effects on spinal stability. A three-dimensional lumbar-sacral spine model was used to evaluate the biomechanical metrics, such as stress on the endplate, shear force on the annulus fibrosus, pressure inside the intervertebral disc, and range of motion (ROM), for both approaches. The results showed that the contralateral approach had better biomechanical properties and caused less deterioration compared to the ipsilateral approach. The contralateral approach is considered an ideal surgical alternative for treating lumbar disc herniation due to its low facet joint reduction rate and minimal soft tissue injury

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : most specialised treatment facility in UK

Published article

CONCLUSION: The contralateral approach, which is now extensively employed in unilateral bilateral endoscopic spine surgery, may be regarded as an ideal surgical alternative for treating lumbar disc herniation without producing iatrogenic instability. This approach has a low facet joint reduction rate, minimum soft tissue injury, and precisely identifies the midline of the central spinal canal during the retraction of the thecal sac and nerve roots.

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J Orthop Surg Res. 2023 Dec 20;18(1):979. doi: 10.1186/s13018-023-04476-z.ABSTRACTBACKGROUND: Unilateral bilateral endoscopic spine surgery (UBE) is often performed to treat lumbar spinal stenosis and disc herniation. It has become a prominent method in endoscopic spine surgery because of its very low learning curve and broader operative field of vision. Currently, the ipsilateral approach and contralateral,

J Orthop Surg Res. 2023 Dec 20;18(1):979. doi: 10.1186/s13018-023-04476-z.

ABSTRACT

BACKGROUND: Unilateral bilateral endoscopic spine surgery (UBE) is often performed to treat lumbar spinal stenosis and disc herniation. It has become a prominent method in endoscopic spine surgery because of its very low learning curve and broader operative field of vision. Currently, the ipsilateral approach and contralateral approach have been established for disc herniation in the foraminal area, intervertebral foramen region, or pedicle region. The contralateral method offers many benefits over the ipsilateral approach, including less bone labour during microsurgical decompression and the preservation of facet joints. However, because it uses the interlaminar window approach, it inevitably involves osteotomy of the patient’s superior and inferior articular processes, which may result in corresponding deterioration in the spine’s biomechanical stability and subsequent adjacent facet joint diseases caused by facet joint degeneration postoperatively.

OBJECTIVE: As a result, the purpose of this work is to use a finite element model to evaluate how the ipsilateral approach and contralateral approach in unilateral bilateral endoscopic spine surgery affect spinal stability while treating identical intervertebral disc herniation.

STUDY DESIGN: In this study, a three-dimensional lumbar-sacral spine model was built and verified. Osteotomies were conducted for armpit-type lumbar disc herniation (LDH), periradicular-type LDH, and shoulder-type LDH. Postoperative lumbar spine models of the ipsilateral approach and contralateral approach in unilateral bilateral endoscopic spine surgery were developed. The von Mises stress on the endplate, shear force on the annulus fibrosus, pressure inside the intervertebral disc, and range of motion (ROM) of the L3 segment were all determined. The results of our well-validated model showed that osteotomy done in the ipsilateral approach deteriorated most biomechanical metrics.

RESULTS: In the majority of loading conditions, the contralateral approach caused the intervertebral disc’s biomechanical properties to increase, and the ipsilateral approach caused the intervertebral disc’s biomechanical properties to increase sharply more than the contralateral approach.

CONCLUSION: The contralateral approach, which is now extensively employed in unilateral bilateral endoscopic spine surgery, may be regarded as an ideal surgical alternative for treating lumbar disc herniation without producing iatrogenic instability. This approach has a low facet joint reduction rate, minimum soft tissue injury, and precisely identifies the midline of the central spinal canal during the retraction of the thecal sac and nerve roots.

PMID:38124107 | DOI:10.1186/s13018-023-04476-z

The London Spine Unit : most specialised treatment facility in UK

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Finite element mechanical analysis of ipsilateral approach and contralateral approach in unilateral bilateral endoscopic spine surgery

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J Orthop Surg Res. 2023 Dec 20;18(1):979. doi: 10.1186/s13018-023-04476-z.ABSTRACTBACKGROUND: Unilateral bilateral endoscopic spine surgery (UBE) is often performed to treat lumbar spinal stenosis and disc herniation. It has become a prominent method in endoscopic spine surgery because of its very low learning curve and broader operative field of vision. Currently, the ipsilateral approach and contralateral

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