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The Biomechanics of the Transpedicular Endoscopic Approach – Lumbar Spinal Stenosis

This article presents a biomechanical cadaveric study that aimed to analyze the effects of an endoscopic transpedicular approach with different drill diameters on the stability of the pedicle. The study found that the transpedicular approach significantly reduces the axial resistance force of the pedicle, potentially leading to pedicle fracture. However, the influence of the drill hole diameter was found to have a limited role. The study also revealed a positive correlation between bone quality and the resistance force of the pedicle. This research highlights the biomechanical effects of endoscopic transpedicular decompression, which has been shown to be beneficial for down-migrated lumbar disc herniations in clinical studies

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
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Published article

CONCLUSION: Transpedicular approach significantly reduces the axial resistance force of the pedicle, which may lead to pedicle fracture. Bone quality correlated positively with the absolute resistance force of the pedicle, whereas the influence of the drill hole diameter plays only a limited role.

Lumbar Decompression Surgery Expert. Best Spinal Surgeon UK
Spine (Phila Pa 1976). 2023 Nov 7. doi: 10.1097/BRS.0000000000004871. Online ahead of print.ABSTRACTSTUDY DESIGN: Biomechanical cadaveric study.OBJECTIVE: The goal of this study was to analyze the effects of an endoscopic transpedicular approach with different drill diameters (6 and 8 mm) to compare them with the intact native side. In addition, the influence of bone quality,

Spine (Phila Pa 1976). 2023 Nov 7. doi: 10.1097/BRS.0000000000004871. Online ahead of print.

ABSTRACT

STUDY DESIGN: Biomechanical cadaveric study.

OBJECTIVE: The goal of this study was to analyze the effects of an endoscopic transpedicular approach with different drill diameters (6 and 8 mm) to compare them with the intact native side. In addition, the influence of bone quality on the resistance of the pedicle was investigated.

SUMMARY OF BACKGROUND DATA: Clinical studies have repeatedly highlighted the benefits of endoscopic transpedicular decompression for down-migrated lumbar disc herniations. However, the biomechanical effects on pedicle stability have not been studied up to now.

METHODS: Twenty-four vertebras originating from four fresh-frozen cadavers were tested under uniaxial compression load in a ramp-to-failure test: (1) the tunneled pedicle on one side, and (2) the native pedicle on the other side. Twelve lumbar vertebrae were assigned to a drill diameter of 6 mm and the other 12 to a diameter of 8 mm.

RESULTS: The median ratio of sustained force for the operated side compared to the intact contralateral side is equal to 74% (63-88) for both drill diameters combined. An 8 mm transpedicular approach recorded an axial resistance of 77% (60-88) compared to the intact contralateral side ( P =0.002). A 6 mm approach resulted in an axial resistance of 72% (66-84) compared to the intact opposite side ( P =0.01). No significant difference between the two different drill diameters was recorded ( P =1). For all 3 subgroups (intact, 8 mm, 6 mm) the HU-values and the absolute resistance force showed significant correlations (intact: ρ=0.859; P <0.001; 8 mm: ρ=0.902; P <0.001; 6 mm: ρ=0.835; P <0.001).

CONCLUSION: Transpedicular approach significantly reduces the axial resistance force of the pedicle, which may lead to pedicle fracture. Bone quality correlated positively with the absolute resistance force of the pedicle, whereas the influence of the drill hole diameter plays only a limited role.

PMID:37942817 | DOI:10.1097/BRS.0000000000004871

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The Biomechanics of the Transpedicular Endoscopic Approach

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Spine (Phila Pa 1976). 2023 Nov 7. doi: 10.1097/BRS.0000000000004871. Online ahead of print.ABSTRACTSTUDY DESIGN: Biomechanical cadaveric study.OBJECTIVE: The goal of this study was to analyze the effects of an endoscopic transpedicular approach with different drill diameters (6 and 8 mm) to compare them with the intact native side. In addition, the influence of bone quality

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