Indications Selection for Surgeons Training in the Translaminar Percutaneous Endoscopic Discectomy Based on Finite Element Analysis
Background. Translaminar percutaneous endoscopic discectomy (PED) was used widely in the treatment of lumbar disc herniation (LDH), especially for the training of novice surgeons. A larger range of osteotomy was a suitable method to get enough operation space and reduce intraoperative risks. But ost...
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doaj-381d0cabcdd14e559c3de4d578c0a89c2020-11-25T02:11:18ZengHindawi LimitedBioMed Research International2314-61332314-61412020-01-01202010.1155/2020/29606422960642Indications Selection for Surgeons Training in the Translaminar Percutaneous Endoscopic Discectomy Based on Finite Element AnalysisJingchi Li0Wenqiang Xu1Qingfeng Jiang2Zhipeng Xi3Xiaoyu Zhang4Nan Wang5Lin Xie6Yang Liu7Department of Spine Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine for Nanjing University of Chinese Medicine, Nanjing 210028, Jiangsu, ChinaDepartment of Spine Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine for Nanjing University of Chinese Medicine, Nanjing 210028, Jiangsu, ChinaDepartment of Anatomy, School of Basic Medical Sciences of Southwest Medical University, Luzhou 646000, Sichuan, ChinaDepartment of Spine Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine for Nanjing University of Chinese Medicine, Nanjing 210028, Jiangsu, ChinaDepartment of Spine Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine for Nanjing University of Chinese Medicine, Nanjing 210028, Jiangsu, ChinaDepartment of Spine Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine for Nanjing University of Chinese Medicine, Nanjing 210028, Jiangsu, ChinaDepartment of Spine Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine for Nanjing University of Chinese Medicine, Nanjing 210028, Jiangsu, ChinaDepartment of Spine Surgery, Changzheng Hospital Affiliated to the Naval Medical University, Shanghai 200041, ChinaBackground. Translaminar percutaneous endoscopic discectomy (PED) was used widely in the treatment of lumbar disc herniation (LDH), especially for the training of novice surgeons. A larger range of osteotomy was a suitable method to get enough operation space and reduce intraoperative risks. But osteotomy, especially facetectomy, may be associated with the biomechanical deterioration and resulting adjacent segment diseases (ASD). Hence, the objects of this study were to investigate whether different levels of surgical experience in performing different ranges of osteotomy (especially facetectomy) affected the risk for ASD and to identify the safe indications for the training of PED novice surgeons. Study Design. In this study, a three-dimensional lumbosacral model was constructed and validated. Corresponding translaminar PED models with different ranges of osteotomy for armpit, periradicular, and shoulder types of LDH were constructed. The von Mises stress on the endplates, the shear stress on the annulus, the intradiscal pressure, and the range of motion (ROM) in the L3-L4 segment disc were computed. Results. Computational results in our well-validated model indicated that large ranges of osteotomy led to deterioration in most of the biomechanical indicators, and this trend was most significant in the shoulder-type LDH model. Conclusions. To ensure the appropriateness of the surgical prognosis, armpit and periradicular types of LDH can be seen as suitable indications for the training of novice PED surgeons, and shoulder-type LDH should be excluded from such indications until novices can perform PED within a relatively small range of osteotomy. Mini Abstract. Based on biomechanical variations in our finite element analysis, armpit and periradicular types of LDH can be seen as suitable indications for the training of novice PED surgeons, and shoulder-type LDH should be excluded until novices can perform PED within a relatively small range of osteotomy.http://dx.doi.org/10.1155/2020/2960642 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Jingchi Li Wenqiang Xu Qingfeng Jiang Zhipeng Xi Xiaoyu Zhang Nan Wang Lin Xie Yang Liu |
spellingShingle |
Jingchi Li Wenqiang Xu Qingfeng Jiang Zhipeng Xi Xiaoyu Zhang Nan Wang Lin Xie Yang Liu Indications Selection for Surgeons Training in the Translaminar Percutaneous Endoscopic Discectomy Based on Finite Element Analysis BioMed Research International |
author_facet |
Jingchi Li Wenqiang Xu Qingfeng Jiang Zhipeng Xi Xiaoyu Zhang Nan Wang Lin Xie Yang Liu |
author_sort |
Jingchi Li |
title |
Indications Selection for Surgeons Training in the Translaminar Percutaneous Endoscopic Discectomy Based on Finite Element Analysis |
title_short |
Indications Selection for Surgeons Training in the Translaminar Percutaneous Endoscopic Discectomy Based on Finite Element Analysis |
title_full |
Indications Selection for Surgeons Training in the Translaminar Percutaneous Endoscopic Discectomy Based on Finite Element Analysis |
title_fullStr |
Indications Selection for Surgeons Training in the Translaminar Percutaneous Endoscopic Discectomy Based on Finite Element Analysis |
title_full_unstemmed |
Indications Selection for Surgeons Training in the Translaminar Percutaneous Endoscopic Discectomy Based on Finite Element Analysis |
title_sort |
indications selection for surgeons training in the translaminar percutaneous endoscopic discectomy based on finite element analysis |
publisher |
Hindawi Limited |
series |
BioMed Research International |
issn |
2314-6133 2314-6141 |
publishDate |
2020-01-01 |
description |
Background. Translaminar percutaneous endoscopic discectomy (PED) was used widely in the treatment of lumbar disc herniation (LDH), especially for the training of novice surgeons. A larger range of osteotomy was a suitable method to get enough operation space and reduce intraoperative risks. But osteotomy, especially facetectomy, may be associated with the biomechanical deterioration and resulting adjacent segment diseases (ASD). Hence, the objects of this study were to investigate whether different levels of surgical experience in performing different ranges of osteotomy (especially facetectomy) affected the risk for ASD and to identify the safe indications for the training of PED novice surgeons. Study Design. In this study, a three-dimensional lumbosacral model was constructed and validated. Corresponding translaminar PED models with different ranges of osteotomy for armpit, periradicular, and shoulder types of LDH were constructed. The von Mises stress on the endplates, the shear stress on the annulus, the intradiscal pressure, and the range of motion (ROM) in the L3-L4 segment disc were computed. Results. Computational results in our well-validated model indicated that large ranges of osteotomy led to deterioration in most of the biomechanical indicators, and this trend was most significant in the shoulder-type LDH model. Conclusions. To ensure the appropriateness of the surgical prognosis, armpit and periradicular types of LDH can be seen as suitable indications for the training of novice PED surgeons, and shoulder-type LDH should be excluded from such indications until novices can perform PED within a relatively small range of osteotomy. Mini Abstract. Based on biomechanical variations in our finite element analysis, armpit and periradicular types of LDH can be seen as suitable indications for the training of novice PED surgeons, and shoulder-type LDH should be excluded until novices can perform PED within a relatively small range of osteotomy. |
url |
http://dx.doi.org/10.1155/2020/2960642 |
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