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  • Title: [Biomechanics changes of lumbar spine caused by foraminotomy via percutaneous transforaminal endoscopic lumbar discectomy].
    Author: Qian J, Yu SS, Liu JJ, Chen L, Jing JH.
    Journal: Zhonghua Yi Xue Za Zhi; 2018 Apr 03; 98(13):1013-1018. PubMed ID: 29690712.
    Abstract:
    Objective: To analyze the biomechanics changes of lumbar spine caused by foraminotomy via percutaneous transforaminal endoscopic lumbar discectomy using the finite element method. Methods: Three healthy adult males (aged 35.6 to 42.3 years) without spinal diseases were enrolled in this study and 3D-CT scans were carried out to obtain the parameters of lumbar spine. Mimics software was applied to build a 3D finite element model of lumbar spine. Graded resections (1/4, 2/4, 3/4 and 4/4) of the left superior articular process of L(5) were done via percutaneous transforaminal endoscopic lumbar discectomy. Then, the pressure of the L(4/5) right facets, the pressure of the L(4/5) intervertebral disc and the motion of lumbar spine were recorded after simulating the normal flexion and extension, lateral flexion and rotation of the lumbar spine model during different resections. The data were compared among groups with analysis of variance. Results: Comparing with the normal group, after 1/4 resection of the left superior articular process of L(5), the pressure of the L(4/5) right facets showed significant differences during left lateral flexion and rotation of lumbar spine (q=8.823, 8.248, both P<0.05); and the pressure of L(4/5) intervertebral disc also changed significantly during extension and right rotation of lumbar spine (q=6.918, 6.438, both P<0.05); the motion of lumbar spine showed obvious differences during right lateral flexion and rotation (q=6.845, 7.772, 13.58, all P<0.05). Comparing with the normal group, after 2/4 resection of the left superior articular process of L(5), the pressure of the L(4/5) right facets presented significant differences during all conditions (q=5.670-17.830, all P<0.05); the pressure of L(4/5) intervertebral disc changed significantly during flexion, extension, lateral flexion and right rotation (q=5.260, 17.150, 5.727, 8.890, 15.660, all P<0.05); the motion of lumbar spine also existed differences during extension, lateral flexion and rotation (q=9.106, 5.431, 12.060, 11.160, 17.260, all P<0.05). However, after 3/4 resections, the pressure of the L(4/5) right facets, the pressure of the L(4/5) intervertebral disc and the motion of lumbar spine presented differences during all conditions when compared with those in normal group (q=6.303-25.48, all P<0.05). After 4/4 resections, the pressure of the L(4/5) right facets and the pressure of the L(4/5) intervertebral disc and the motion of lumbar spine showed significant differences during all conditions when compared with those in normal group (q=8.065-45.70, all P<0.05). Conclusions: The biomechanics and the stability of lumbar spine changed partly after 1/4 resection of the superior articular process and obviously after more than 2/4 is resected. The superior articular process should be paid more attention during foraminotomy via percutaneous transforaminal endoscopic lumbar discectomy. 目的： 采用有限元法分析全脊柱内镜下椎间孔成型对腰椎生物力学的影响。 方法： 2016年8月选取健康成年男性3名，年龄35.6～42.3岁，排除脊柱疾患。进行腰椎3D－CT扫描，获取腰椎CT参数。应用Mimics等软件进行数据处理获得腰椎有限元三维模型。依次模拟腰椎侧路全脊柱内镜应用下将L(5)左侧上关节突进行1/4、2/4、3/4和4/4分级切除，并给予载荷模拟正常腰椎进行屈伸、侧屈和旋转活动，记录不同切除状态下L(4/5)右侧关节突间压力、L(4/5)椎间盘压力和腰椎活动度，并与未切除组或进行组间比较。组间比较用方差分析，两两比较用SNK检验。 结果： 与未切除组相比，L(5)左侧上关节突切除1/4时，L(4/5)右侧关节突间压力在左侧屈及左旋转载荷下差异有统计学意义(q＝8.823、8.248，均P<0.05)；L(4/5)椎间盘内压力在后伸及右旋转载荷下差异有统计学意义(q＝6.918、6.438，均P<0.05)；腰椎活动度在右侧屈及左右旋转载荷下差异有统计学意义(q＝6.845、7.772、13.580，均P<0.05)。L(5)左侧上关节突切除2/4时，与未切除组对比，L(4/5)右侧关节突间压力在各载荷下差异均有统计学意义(q＝5.670～17.830，均P<0.05)；L(4/5)椎间盘内压力在前屈后伸、左右侧屈及右旋转载荷下差异有统计学意义(q＝5.260、17.150、5.727、8.890、15.660，均P<0.05)；腰椎活动度在后伸、左右侧屈及左右旋转载荷下差异有统计学意义(q＝9.106、5.431、12.060、11.160、17.260，均P<0.05)。L(5)左侧上关节突切除3/4时，与未切除组相比，L(4/5)右侧关节突间压力在各载荷下差异均有统计学意义(q＝6.518～26.870，均P<0.05)；L(4/5)椎间盘内压力在各载荷下差异均有统计学意义(q＝6.867～25.190，均P<0.05)；腰椎活动度在各载荷下差异均有统计学意义(q＝6.303～20.720，均P<0.05)。L(5)左侧上关节突切除4/4时，与未切除组相比，L(4/5)右侧关节突间压力在各载荷下差异均有统计学意义(q＝11.880～45.70，均P<0.05)；L(4/5)椎间盘内压力在各载荷下差异均有统计学意义(q＝11.120～82.210，均P<0.05)；腰椎活动度在各载荷下差异均有统计学意义(q＝8.065～22.520，均P<0.05)。 结论： 腰椎上关节突切除1/4即会部分影响腰椎的力学并影响腰椎的稳定性，切除2/4及以上即会明显破坏腰椎的稳定性；全脊柱内镜下椎间孔成型时可能需要注意对腰椎上关节突的保护。.
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