Comparison of bone reamer and trephine for foraminoplasty in ...

Foraminoplasty constitutes a vital component in Percutaneous Endoscopic Lumbar Discectomy (PELD), particularly when utilizing the TESSYS technique. The choice of instrument for foraminoplasty can significantly influence the volume of bone resection and the degree of X-ray exposure during the procedure. Two primary tools utilized in current clinical practice are bone reamers and trephines, each presenting its own set of benefits and limitations.

Bone reamers have the advantage of better preserving bone mass; however, this comes at the cost of lower efficiency and increased X-ray exposure. Conversely, trephines are more efficient but result in a higher volume of bone resection, potentially jeopardizing lumbar stability. This study aims to find a balance between minimizing X-ray exposure and bone resection volume, providing a theoretical foundation for selecting appropriate tools in clinical scenarios.

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Volume of Bone Resection and Impact on Lumbar Stability

In terms of bone resection volume, the bone reamer (Group-R) resulted in significantly less bone removal (173.22 ± 88.19 mm³) compared to the trephine (Group-T), which recorded a resection volume of (549.31 ± 231.43 mm³). Two factors contribute to this discrepancy: the bone reamer operates through friction generated by rotating front teeth, limiting bone removal, while the trephine employs shearing force via rotating annular teeth, allowing extensive bone resection. Notably, Group-R also destroyed less of the superior articular process (SAP) than Group-T, implying a lower risk of postoperative lumbar instability associated with bone reamers.

X-Ray Exposure and Foraminoplasty Efficiency

When comparing X-ray exposure, Group-R required significantly more fluoroscopic views (20.52 ± 5.38 times) than Group-T (13.25 ± 3.06 times). This increase is attributed to the stepwise approach needed with bone reamers, necessitating multiple insertions and adjustments to achieve effective foraminoplasty. In contrast, the anchoring capability of the trephine's annular serrations aids in continuous and efficient reaming, reducing X-ray exposure and procedure time. Consequently, trephines provide a more efficient alternative for foraminoplasty, albeit at the expense of higher bone removal.

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Conclusion and Practical Recommendations

Statistical analysis suggests a significant correlation between the number of fluoroscopic views and the preoperative area of the foramenotomy perimeters (FPZ). When the FPZ exceeds 54.55 mm², the bone reamer's head end (7.5 mm) can effectively enter the foramen, reducing the chance of slippage and decreasing the number of required fluoroscopic views. This highlights the critical role of preoperative planning in ensuring the efficiency of foraminoplasty.

Despite its merits, the study's limitations include its small sample size and the challenges in measuring FPZ area. Future studies should consider larger populations and advanced imaging techniques to improve accuracy and reliability.

Explore further details about intervertebral foramen surgical trephines.

Trephines boast a fast-lock mechanism for easy attachment to various handles, facilitating the use of different sizes of ring saws. Essential for procedures like laminotomy and for expanding the intervertebral foramen, these trephines play a crucial role in establishing a clear endoscopic channel, thus enabling precise and efficient access to the affected spinal disc.

For further information, feel free to explore details on intervertebral foramen surgical trephines.