Comparison of SpineJet™ XL and Conventional Instrumentation for Disk Space Preparation in Unilateral Transforaminal Lumbar Interbody Fusion
Department of Neurosurgery, St. Paul's Hospital, The Catholic University of Korea, Seoul, Korea.Journal of Korean Neurosurgical Society (Impact Factor: 0.64). 05/2010; 47(5):370-6. DOI: 10.3340/jkns.2010.47.5.370
Although unilateral transforaminal lumbar interbody fusion (TLIF) is widely used because of its benefits, it does have some technical limitations. Removal of disk material and endplate cartilage is difficult, but essential, for proper fusion in unilateral surgery, leading to debate regarding the surgery's limitations in removing the disk material on the contralateral side. Therefore, authors have conducted a randomized, comparative cadaver study in order to evaluate the efficiency of the surgery when using conventional instruments in the preparation of the disk space and when using the recently developed high-pressure water jet system, SpineJet™ XL.
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ABSTRACT: Randomized, technical study in 7 samples from 2 cadavers. To compare transforaminal lumbar discectomies performed by 2 experienced surgeons using either the conventional technique or the new powered Spine Shaver (SS) instrument. The SS was designed to offer an easier and safer procedure than the conventional technique. The 7 samples were randomly operated by the 2 surgeons. The conventional or SS techniques were randomly selected. The endplate cartilage was removed and photographed. The amounts of cartilage removed were measured through computer-based analysis software. The number of instrument insertions was nearly 6-fold more frequent with the conventional technique (56.4) than with the SS (12.3). The volume of disk removed was approximately 50% higher with the SS (6.525 cm) than with the conventional technique (4.333 cm). The areas of cartilages removed were higher using the SS (2.297 cm) than with the conventional technique (2.1 cm). The endplate damages were 0.1 and 0.3 cm for the SS and conventional techniques, respectively. The SS allows a better quality of preparation, and minimizes the risks of damaging surrounding structures related to multiple movements of manual tools.
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ABSTRACT: Cadaveric laboratory study. To quantify and compare automated disk-space preparation with traditional methods. Removal of nucleus pulposus to prepare a disk space for interbody fusion is performed with various techniques. Our aim was to determine the safety and effectiveness of an automated technique in comparison to traditional methods and gauge its expected clinical application. This study was conducted in 2 phases. In the phase 1 safety trial, ''maximal'' force was applied to an automated shaver against cadaveric annulus and endplates until flexion of the shaft caused the blades to bind. This simulated the risk of creating an incidental cortical or annular defect. In phase 2, 27 cadaveric lumbar disk spaces were randomized to traditional or automated preparation techniques through a standard transforaminal lumbar interbody fusion approach. Traditional method comprised the use of paddle shavers, pituitary rongeurs, and curettes. Automated technique involved insertion of an 8-mm paddle shaver, followed by straight and angled hand pieces to remove nucleus pulposus and endplate cartilage. Unintended cortical and annular breaches, preparation time, instrument insertions, percentage area of exposed endplate underlying the nucleus pulposus, and percentage volume of nuclear space cleared were measured and compared. In phase 1, ''maximal'' force applied for 10 seconds produced no full-thickness annular or cortical defects. In phase 2, automated technique produced fewer endplate cortical defects (3 vs. 7) and full-thickness annular breaches (0 vs. 1), required fewer instrument insertions (29 vs. 6; P<0.001), exposed more endplate (65% vs. 52%; P=0.037), and removed more nucleus pulposus volume (83% vs. 59%; P=0.01). Automated shaving decreased instrument insertions and prepared the disk space more effectively, with fewer cortical or annular defects. This technique holds promise for improved outcomes in spinal fusion surgery.
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ABSTRACT: : Cadaveric study. : The purpose of this study was to assess the influence of surgical experience on the efficiency of lumbar discectomy in open transforaminal lumbar interbody fusion. : There is limited knowledge about the efficiency of discectomy among surgeons. As a first study, we are evaluating the effect of surgical experience on it. : Manual and powered discectomies were randomized and performed by 3 attending spine surgeons and 2 clinical spine fellows. Each discectomy procedure was analyzed for the area of complete endplate preparation, total elapsed time, and number of instrument passes. The surface area of discectomy at each endplate was measured utilizing digital imaging and the appropriate software. For the purpose of the analysis, the superior and the inferior endplates were divided into ipsilateral and contralateral halves, and each half was further divided into ventral and dorsal quadrants. Each quadrant was analyzed in a blinded manner by 2 observers. : A total of 40 discectomies were performed on 9 fresh-frozen cadaveric torsos between the levels T12 and S1. A powered discectomy device was used in levels 9 and 11 by the attendings. Manual discectomy was performed in 11 levels by the spine fellows and 9 by the spine attendings. No significant difference was observed between the spine fellows and spine attendings when the manual instruments were used (P=0.924). However, the spine attending surgeon group had a significantly increased total area of discectomy compared with the fellows (P=0.003). No significant difference was observed between the groups when instrument passes or the total elapsed time were compared either utilizing the manual or the powered technique. : Our results demonstrate that a satisfactory discectomy may be performed by surgeons with relatively less surgical experience in the transforaminal approach using a powered discectomy device.