J Neurosurg Spine. 2017 Apr;26(4):454-458. doi: 10.3171/2016.9.SPINE16283. Epub 2017 Jan 27.
OBJECTIVE This purpose of this study was to objectively evaluate and assess the efficacy and efficiency of discectomy and endplate preparation during transforaminal lumbar interbody fusion (TLIF) using traditional manual instrumentation versus a novel suction discectomy curette. Transforaminal lumbar interbody fusion is the most widely used approach for lumbar arthrodesis, and its success depends on the ability to achieve fusion. Complete preparation of intervertebral disc space (removal of the nucleus, endplate cartilage, and margin of inner annulus) is the surgical goal. Performing an adequate discectomy requires numerous instrument passes, increasing surgical time and the risk of complications. METHODS Four experienced spinal surgeons performed transforaminal discectomies from T-12 to S-1 on 5 whole-body cadavers. Each level (n = 26) was randomly assigned to either a control group using traditional instruments (12 levels) or to a suction curette group (14 levels). The time required to perform the discectomy and the number of passes through the annulus were recorded. Motion segments were dissected and analyzed by digital photogrammetric analysis. The intervertebral disc and the discectomy cross-sectional areas were measured on both superior and inferior images of each dissected surgical level. Areas were divided into 4 quadrants based on a midsagittal and midcoronal axis and analyzed for regional efficiency. In addition, a cross-sectional area of bony endplate (the area still covered with cartilage) and an area of endplate perforation were evaluated. RESULTS There was no significant difference in surgical time between the techniques (7:51 ± 2:43 minutes in the manual discectomy [MD] group and 7:06 ± 3:33 minutes in the suction curette discectomy [SD] group). There were significantly fewer (p < 0.01) instrument passes in the SD group (13 passes) compared with the MD group (43 passes). For both techniques, the amount of disc removed depended upon the anatomical region, with the posterior-contralateral side having the least amount of disc material removed. There was significantly less (p < 0.01) disc material removed in the MD group (38%) compared with the SD group (48%). The amount of disc material removed was significantly more (p < 0.05) in each quadrant when comparing the SD and MD groups, with the anterior regions showing the largest difference. For both techniques, the preparation of the endplate within the discectomy area resulted in a mostly cartilaginous interface (50% MD, 48% SD); a smaller amount of bony interface area (31% MD, 38% SD); and a smaller amount of perforation to the interface area (19% MD, 13% SD). There were no significant differences between the groups in terms of endplate preparation. CONCLUSIONS The improved discectomy observed with the suction curette device could potentially improve the clinical fusion rate.
目的 本研究旨在客观评估和比较使用传统手动器械与新型吸引式椎间盘刮匙进行经椎间孔腰椎椎间融合术（TLIF）时椎间盘切除术和终板准备的疗效和效率。经椎间孔腰椎椎间融合术是腰椎融合术最广泛使用的方法，其成功取决于实现融合的能力。椎间盘间隙的完全准备（去除髓核、终板软骨和内环边缘）是手术目标。进行充分的椎间盘切除术需要多次器械操作，这会增加手术时间和并发症风险。
方法 四位经验丰富的脊柱外科医生在5具全身尸体上从T-12至S-1进行经椎间孔椎间盘切除术。每个节段（n = 26）被随机分配至使用传统器械的对照组（12个节段）或吸引刮匙组（14个节段）。记录进行椎间盘切除术所需的时间和穿过纤维环的次数。通过数字摄影测量分析对运动节段进行解剖和分析。在每个解剖手术节段的上下图像上测量椎间盘和椎间盘切除的横截面积。根据矢状轴和冠状轴将区域划分为4个象限，并分析区域效率。此外，评估骨终板的横截面积（仍覆盖软骨的区域）和终板穿孔面积。
结果 两种技术在手术时间上无显著差异（手动椎间盘切除术[MD]组为7:51 ± 2:43分钟，吸引刮匙椎间盘切除术[SD]组为7:06 ± 3:33分钟）。与MD组（43次）相比，SD组（13次）的器械操作次数显著减少（p < 0.01）。对于两种技术，切除的椎间盘量取决于解剖区域，后对侧去除的椎间盘组织最少。与SD组（48%）相比，MD组（38%）切除的椎间盘组织显著更少（p < 0.01）。比较SD组和MD组时，每个象限切除的椎间盘组织量显著更多（p < 0.05），前部区域差异最大。对于两种技术，在椎间盘切除区域内终板的准备导致大部分为软骨界面（MD组50%，SD组48%）；骨界面面积较小（MD组31%，SD组38%）；界面区域穿孔较少（MD组19%，SD组13%）。两组在终板准备方面无显著差异。
结论 使用吸引刮匙装置观察到的改良椎间盘切除术可能会提高临床融合率。
