2023, Vol. 27 ›› Issue (13): 1981-1986

Biomechanical stability and finite element analysis of endoscopic LOVE decompression technique and endoscopic unilateral laminotomy for bilateral decompression technique for lumbar spinal stenosis

Zhang Hanshuo1, 2, 3, Ding Yu1, 2, 3, Jiang Qiang3, Lu Zhengcao3, Lian Shilin3, Li Tusheng3   

Abstract: BACKGROUND: Endoscopic LOVE decompression and endoscopic unilateral laminotomy for bilateral decompression, as cutting-edge and highly precise techniques for posterior spinal endoscopic treatment of lumbar spinal stenosis, have good clinical efficacy. However, there are few reports on biomechanical and finite element analysis.
OBJECTIVE: To study the influence of endoscopic LOVE decompression and endoscopic unilateral laminotomy for bilateral decompression on the biomechanics of endoscopic treatment of lumbar spinal stenosis, and verify the reliability and effectiveness of the two surgical methods in the treatment of lumbar spinal stenosis.
METHODS: The CT image of one volunteer was taken. The finite element model M0 of lumbar L4-L5 segment was established by Mimics, Geomagic, Solidworks and Ansys software. On this basis, an endoscopic LOVE decompression model M1 and an endoscopic unilateral laminotomy for bilateral decompression model M2 were established. The same stress was applied to the upper surface of L4 vertebral body of the three groups of models. The lower surface of L5 vertebral body was fixed and supported. The total range of motion and the Von Mises stress extreme value of the annulus fibrosus were analyzed under six physiological conditions of forward bending, extension, left bending, right bending, left rotation, and right rotation.
RESULTS AND CONCLUSION: (1) Compared with model M0, the overall joint range of motion of model M1 increased by 8.24%, 12.17%, 0.77%, 1.60%, 1.86%, and 6.85% in forward bending, extension, left bending, left rotation, right bending, and right rotation, respectively; the overall joint range of motion of the model M2 increased by 8.24%, 12.17%, 0.77%, 1.60%, 2.17%, and 6.85% in forward bending, extension, left bending, left rotation, right bending, and right rotation, respectively. Compared with the model M1, the overall joint range of motion of the model M2 under the right bending slightly increased, and there was no obvious increase or trend change in the other working conditions. (2) Compared with model M0, the extreme values of Von Mises stress of the annulus fibrosus in model M1 under forward bending, extension, left bending, left rotation, right bending, and right rotation increased by 4.65%, 16.09%, 0.21%, 0.77%, 0.25%, 1.51%, respectively; the extreme values of Von Mises stress of the annulus fibrosus under forward bending, extension, left bending, left rotation, right bending, and right rotation of model M2 increased by 4.58%, 16.15%, 0.20%, 0.80%, 0.23%, and 1.52%, respectively. The variation trends of the extreme value of Von Mises stress of the fibrous annulus of model M1 and model M2 were not obvious under different working conditions. (3) These results confirm that responsibility segment is stable after endoscopic LOVE decompression and endoscopic unilateral laminotomy for bilateral decompression for treatment of lumbar spinal stenosis.
Key words: lumbar spinal stenosis, spinal endoscopy, posterior decompression, surgery, biomechanics, finite element analysis