Huh Han-Yong, Ji Cheol, Ryu Kyeong-Sik, Park Chun-Kun
Department of Neurosurgery, St. Paul's Hospital, The Catholic University of Korea, Seoul, Korea.
J Korean Neurosurg Soc. 2010 May;47(5):370-6. doi: 10.3340/jkns.2010.47.5.370. Epub 2010 May 31.
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.
Two spine surgeons performed diskectomies and disk preparations for TLIF in 20 lumbar disks. All cadaver/surgeon/level allocations for preparation using the SpineJet XL (HydroCision Inc., Boston, MA, USA) or conventional tools were randomized. All assessments were performed by an independent spine surgeon who was unaware of the randomizations. The authors measured the areas (cm(2)) and calculated the proportion (%) of the disk surfaces. The duration of the disk preparation and number of instrument insertions and withdrawals required to complete the disk preparation were recorded for all procedures.
The proportion of the area of removed disk tissue versus that of potentially removable disk tissue, the proportion of the area of removed endplate cartilage, and the area of removed disk tissue in the contralateral posterior portion showed 74.5 +/- 17.2%, 18.5 +/- 12.03%, and 67.55 +/- 16.10%, respectively, when the SpineJet XL was used, and 52.6 +/- 16.9%, 22.8 +/- 17.84%, and 51.64 +/- 19.63%, respectively, when conventional instrumentations were used. The results also showed that when the SpineJet XL was used, the proportion of the area of removed disk tissue versus that of potentially removable disk tissue and the area of removed disk tissue in the contralateral posterior portion were statistically significantly high (p < 0.001, p < 0.05, respectively). Also, compared to conventional instrumentations, the duration required to complete disk space preparation was shorter, and the frequency of instrument use and the numbers of insertions/withdrawals were lower when the SpineJet XL was used.
The present study demonstrates that hydrosurgery using the SpineJet XL unit allows for the preparation of a greater portion of disk space and that it is less traumatic and allows for more precise endplate preparation without damage to the bony endplate. Furthermore, the SpineJet XL appears to provide tangible benefits in terms of disk space preparation for graft placement, particularly when using the unilateral TLIF approach.
尽管单侧经椎间孔腰椎椎间融合术（TLIF）因其优势而被广泛应用，但它确实存在一些技术局限性。在单侧手术中，去除椎间盘组织和终板软骨对于实现良好融合很困难但又至关重要，这引发了关于该手术在对侧去除椎间盘组织方面局限性的争论。因此，作者进行了一项随机对照尸体研究，以评估在使用传统器械准备椎间盘间隙以及使用最近研发的高压水刀系统SpineJet XL时该手术的效率。
两位脊柱外科医生对20个腰椎间盘进行了TLIF的椎间盘切除术和椎间盘准备工作。使用SpineJet XL（美国马萨诸塞州波士顿市的HydroCision公司）或传统工具进行准备的所有尸体/外科医生/节段分配均是随机的。所有评估均由一位不知道随机分组情况的独立脊柱外科医生进行。作者测量了面积（平方厘米）并计算了椎间盘表面的比例（%）。记录了所有手术完成椎间盘准备所需的时间以及器械插入和拔出的次数。
使用SpineJet XL时，切除的椎间盘组织面积与潜在可切除椎间盘组织面积的比例、切除的终板软骨面积以及对侧后部切除的椎间盘组织面积分别为74.5±17.2%、18.5±12.03%和67.55±16.10%；使用传统器械时，上述比例分别为52.6±16.9%、22.8±17.84%和51.64±19.63%。结果还显示，使用SpineJet XL时，切除的椎间盘组织面积与潜在可切除椎间盘组织面积的比例以及对侧后部切除的椎间盘组织面积在统计学上显著更高（分别为p<0.001，p<0.05）。此外，与传统器械相比，使用SpineJet XL完成椎间盘间隙准备所需的时间更短，器械使用频率以及插入/拔出次数更低。
本研究表明，使用SpineJet XL装置的水刀手术能够准备更大比例的椎间盘间隙，并且创伤更小，能够更精确地准备终板而不损伤骨质终板。此外，在为植入移植物准备椎间盘间隙方面，SpineJet XL似乎具有明显优势，尤其是在采用单侧TLIF手术方式时。
