Biomechanical evaluation of percutanous transforaminal endoscopic lumbar interbody fusion with differentfixation methods in the treatment of lumbar instability
DING Yu
ZHU Teng-Yue
RUAN Di-ke
ZHANG Jing
XU Cheng
ZHANG Jian-jun
ZHU Kai
DU Wei
DONG Yan-han
Abstract：Objective To observe the biomechanical stability of percutanous transforaminal endoscopic lumbar interbody fusion ( modified-TLIF ) with different fixation methods in the treatment of lumbar instability. Methods Six fresh calf spine columns were harvested in the study. Segment instability model was prepared, and then different fixation methods with modified-TLIF were performed to rebuild the spinal stability. Spine specimens were loaded at flexion, extension, lateral bending and axial rotation states. Values of three-dimensional movement range of motion ( ROM ) were measured separately. Biomechanical test sequence: Group A ( entire spine column ), Group B ( segmental instability ), Group C ( simulating endoscopy assisted modified-TLIF with single cage ), Group D ( single cage combining with bilateral facet joint screws ), Group E ( single cage combining with unilateral pedicle screw system ), Group F ( single cage combining with bilateral pedicle screw system ). Results Compared with Group A:Group B presented significantly increased 3-d movement ROM values ( P < 0.05 ); Group C presented significantly decreased ROM value with extension ( P < 0.05 ), and significantly increased ROM value with flexion ( P < 0.05 );Group D / E / F presented significantly decreased ROM values at the six 3-d movement states ( P < 0.05 ). Compared with Group F: Group A / B / C presented significantly increased ROM values at the six 3-d movement states ( P < 0.05 );Group D presented significantly increased ROM values at flexion and axial rotation states ( P < 0.05 ), while no other changes were observed in other motions ( P > 0.05 ); Group E presented significantly increased ROM values at flexion and right lateral bending ( P < 0.05 ), while no other changes were observed in other motions ( P > 0.05 ). Conclusions Endoscopy assisted Modified-TLIF can effectively rebuild the stability of spinal segments, and can be applied in the treatment of single segmental instability. Single oblique cage combining with bilateral facet joint screws or unilateral pedicle screw system can both meet biomechanical requirements with ideal mechanical properties.
Keywords：Lumbar vertebraeSpinal diseasesMinimally invasive surgical proceduresEndoscopesSpinal fusionBiomechanics
Publication Date：2017-01-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：6( 724-729 )