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Stability simulation analysis of targeted puncture in L4/5 intervertebral space for PELD surgery
Yuhuai Liu1, Qiongchi Zhang1, Ning Ji1
1Department of Orthopedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
Frontiers in Bioengineering and Biotechnology
|January 23, 2024
Summary
Choosing the right entry angle for percutaneous endoscopic lumbar discectomy (PELD) minimizes lumbar damage. Optimal angles are 30° for interlaminar and 60° for transforaminal approaches, enhancing postoperative stability.
Area of Science:
- Spine Surgery
- Minimally Invasive Procedures
- Biomechanical Analysis
Background:
- Percutaneous endoscopic lumbar discectomy (PELD) is a minimally invasive technique for lumbar disc herniation.
- Optimizing the trephine entry angle is crucial for minimizing lumbar damage and improving postoperative stability.
- Understanding the biomechanical impact of different entry angles is essential for surgical planning.
Purpose of the Study:
- To determine the optimal trephine entry angle for percutaneous endoscopic lumbar discectomy (PELD) at the L4/5 intervertebral space.
- To analyze the degree of lumbar damage and postoperative stability associated with different trephine osteotomy angles.
- To compare the biomechanical effects of various entry angles using three-dimensional simulation and Finite Element Analysis (FEA).
Main Methods:
- Construction of a lumbar model using patient CT data.
- Three-dimensional simulation to analyze trephine osteotomy volume variations at different entry angles (L4/5 interspace).
- Finite Element Analysis (FEA) to assess range of motion and von Mises stress under mechanical loads.
Main Results:
- For percutaneous endoscopic interlaminar discectomy (PEID), a 20° angle yielded the smallest osteotomy volume, increasing at 30° and peaking at 40°.
- For percutaneous transforaminal endoscopic discectomy (PTED), a 70° angle resulted in the smallest osteotomy volume, with larger volumes at 60° and 50°.
- FEA indicated significant biomechanical decline (M6) during posterior extension and right rotation; M2, M3, M4, and M5 showed variations in rotation and extension.
Conclusions:
- Selecting appropriate entry sites and angles significantly reduces lumbar damage and enhances postoperative stability.
- Recommended optimal angles are 30° for PEID and 60° for PTED at the L4/5 intervertebral space.
- Minimizing facet joint damage is critical for improving the stability of lumbar motion units post-surgery.
