Biomechanical effects of incremental resection of the ligamentum flavum and lumbar facet joint using a contralateral endoscopic approach
Year: 2025
Type: article
Abstract: PURPOSE: This study aimed to evaluate the biomechanical effects of progressively removing ligamentous structures and the facet joint using a contralateral endoscopic approach. MATERIALS AND METHODS: Twenty spinal segments were biomechanically evaluated in a load-controlled study to assess the impact of resection of the yellow ligament and stepwise resection of facet joint (1/3 and 2/3) using a contralateral endoscopic approach on segmental range of motion (ROM). ROM was compared between the native state and after stepwise resection of contralateral structures. The segments were tested under various loading conditions: flexion-extension (FE), lateral shear (LS), lateral bending (LB), anteroposterior shear (AS), axial rotation (AR), and axial compression/decompression (AC). RESULTS: The ROM of the vertebral segment increased significantly across all movement directions following stepwise resection, compared to the native intact state, with the greatest effect observed after partial resection of the contralateral facet joint. The most significant increases were seen in LS, AS and AC after two-thirds of the contralateral facet joint was resected: LS increased by 18.5% (1.24° vs. 1.43°, p = 0.03), AS by 22.8% (1.27 mm vs. 1.78 mm, p = 0.0009), and AC by 20.2% (0.39 mm vs. 0.45 mm, p = 0.006). CONCLUSION: The contralateral endoscopic approach should be performed with caution, limiting resection of the facet joint. Excessive removal of the contralateral facet joint can compromise segmental stability and function.
Source: European Spine Journal
Institution: Universitätsklinik Balgrist
Language: English
Subfield: Pathology and Forensic Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $2,790
Funder: Universität Zürich
OpenAlex ID: W4416407932