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- Title
Finite element simulation and biomechanical analysis of fully endoscopic precisely laminectomy decompression.
- Authors
Jiang Qiang; Ding Yu; Liu Jinyu; Cao Shiqi; Lu Zhengcao
- Abstract
BACKGROUND: Minimally invasive endoscopic decompression is currently used in the treatment of lumbar spinal stenosis, but there are few studies on the scope of precise laminectomy under the microscope. OBJECTIVE: To explore the influence of precise decompression with different laminectomy zones on lumbar range of motion and stress distribution using the entire degenerative lumbar finite element modal. METHODS: A patient with lumbar spinal stenosis was randomly selected. Based on CT data, L4-5 segment finite element model (M1) was established using relevant biomechanlcal software, and the validty was verified. After that, the finite element simulation of fully endoacoplc precisely laminectomy decompression operation was performed. Combined with pathological classification of lumbar spinal stenosis, personalized laminectomy decompression aiming al different L4-5 segment stenosis was established, specifically Including L4 lamina margin and partial facet joint resection model (M2). L5 lamina margin and partial facet joint resection modal (M3), L4/6 lamina margin and partial facet Joint resection model (M4), M4 + "Over-the-Top" contralateral partial facet joint resection modal (M5), and L4/6 lamina margin and and over 50% facet joint resection modal (M6). The same boundary loading was applied to the various finite element models. The lumbar range of motion and equivalent stress of lntervertebral dics were compared under six conditions lncluding flexion, extension, left and right flexion, left and right rotation. RESULTS AND CONCLUSION: (1) Compared with the entire M1 model, ranges of motion of M2, M3, M4 and M5 models were similar under various conditions, but range of motion of M6 model was significantly increased to 151%-284% scope, especially In the extension and rotational conditions. (2) In terms of the equivalent stress of disc, the M2, M3, M4 and M5 models showed no obvious lncreasing trend at the anterior, left and right regions under various working conditions. The largest lncrease of the equivalent stress at posterior and middle disc regions was 53% maximally, but with no significant stress concentration. However, the equivalent stress in total disc regions showed a significant Increasing trend In M6 modal, especially In flexion condition with the maximum three times of M1 model. (3) Results suggest that extensive laminectamy can significantly affect the stability of the lumbar spine, with the intervertebral disc stress increase at the corresponding segment which Is more likely to accelerate segmental degeneration. Minimally lnvasive endoscopic decompression is precise and controllable. The personalized decompression schemes can be adapted fur different types of lumbar spinal stenosis to ensure the surgery affect and effectively maintain the biomechanical characteristics of the segments.
- Subjects
ZYGAPOPHYSEAL joint; SPINAL stenosis; INTERVERTEBRAL disk; STRESS concentration; LUMBAR vertebrae; LAMINECTOMY
- Publication
Chinese Journal of Tissue Engineering Research / Zhongguo Zuzhi Gongcheng Yanjiu, 2020, Vol 24, Issue 12, p1891
- ISSN
2095-4344
- Publication type
Article
- DOI
10.3969/j.issn.2095-4344.2520