Finite element mechanical analysis of ipsilateral approach and contralateral approach in unilateral bilateral endoscopic spine surgery
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 ip...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-12-01
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| Series: | Journal of Orthopaedic Surgery and Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13018-023-04476-z |
| _version_ | 1797376848741531648 |
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| author | Wenzheng Li Junjian Han Qingyun Xin Qitao Liu Chao Feng Yichan Liu Dengjun Zhang |
| author_facet | Wenzheng Li Junjian Han Qingyun Xin Qitao Liu Chao Feng Yichan Liu Dengjun Zhang |
| author_sort | Wenzheng Li |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-08T19:45:29Z |
| format | Article |
| id | doaj.art-855a1eb15e354302ba1874c607d95fdd |
| institution | Directory Open Access Journal |
| issn | 1749-799X |
| language | English |
| last_indexed | 2024-03-08T19:45:29Z |
| publishDate | 2023-12-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj.art-855a1eb15e354302ba1874c607d95fdd2023-12-24T12:24:30ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2023-12-0118111410.1186/s13018-023-04476-zFinite element mechanical analysis of ipsilateral approach and contralateral approach in unilateral bilateral endoscopic spine surgeryWenzheng Li0Junjian Han1Qingyun Xin2Qitao Liu3Chao Feng4Yichan Liu5Dengjun Zhang6Department of Orthopaedics, The Fifth Clinical Medical College of Shanxi Medical UniversityDepartment of Orthopaedics, The Fifth Clinical Medical College of Shanxi Medical UniversityDepartment of Orthopaedics, The Fifth Clinical Medical College of Shanxi Medical UniversityDepartment of Orthopaedics, The Fifth Clinical Medical College of Shanxi Medical UniversityDepartment of Orthopaedics, The Fifth Clinical Medical College of Shanxi Medical UniversityShanxi University of Chinese MedicineDepartment of Orthopaedics, The Fifth Clinical Medical College of Shanxi Medical UniversityAbstract 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.https://doi.org/10.1186/s13018-023-04476-zUnilateral bilateral endoscopyLumbar herniated discContralateral approachFinite element methodSpine |
| spellingShingle | Wenzheng Li Junjian Han Qingyun Xin Qitao Liu Chao Feng Yichan Liu Dengjun Zhang Finite element mechanical analysis of ipsilateral approach and contralateral approach in unilateral bilateral endoscopic spine surgery Journal of Orthopaedic Surgery and Research Unilateral bilateral endoscopy Lumbar herniated disc Contralateral approach Finite element method Spine |
| title | Finite element mechanical analysis of ipsilateral approach and contralateral approach in unilateral bilateral endoscopic spine surgery |
| title_full | Finite element mechanical analysis of ipsilateral approach and contralateral approach in unilateral bilateral endoscopic spine surgery |
| title_fullStr | Finite element mechanical analysis of ipsilateral approach and contralateral approach in unilateral bilateral endoscopic spine surgery |
| title_full_unstemmed | Finite element mechanical analysis of ipsilateral approach and contralateral approach in unilateral bilateral endoscopic spine surgery |
| title_short | Finite element mechanical analysis of ipsilateral approach and contralateral approach in unilateral bilateral endoscopic spine surgery |
| title_sort | finite element mechanical analysis of ipsilateral approach and contralateral approach in unilateral bilateral endoscopic spine surgery |
| topic | Unilateral bilateral endoscopy Lumbar herniated disc Contralateral approach Finite element method Spine |
| url | https://doi.org/10.1186/s13018-023-04476-z |
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