Comparison of SpineJet™ XL and Conventional Instrumentation for Disk Space Preparation in Unilateral Transforaminal Lumbar Interbody Fusion

Abstract

Objective : 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 TM XL. Methods : Two spine surgeons performed diskectomies and disk preparations for TLIF in 20 lumbar disks. All cadaver/surgeon/level allocations for preparation using the SpineJet TM 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. Results : 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 TM 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 TM 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 TM XL was used. Conclusion : The present study demonstrates that hydrosurgery using the SpineJet TM 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 TM XL appears to provide tangible benefits in terms of disk space preparation for graft placement, particularly when using the unilateral TLIF approach.

An in vitro study examining a novel suction curette device for lumbar discectomy compared with standard manual discectomy

“…4 However, in vitro studies have shown that discectomy is not always ideal in terms of maximizing the CSA and preparing the endplate. 3,7 In this study, the CSA of the discectomy ranged from 38% to 48% depending upon technique, and this was similar to the overall discectomy areas of the previously mentioned studies. The current study also confirmed, quantitatively, the difficulty of removal of material from the posterior-contralateral region for a TLIF procedure.…”

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T ransforaminal lumbar interbody fusion (TLIF) is arguably the most widely used approach for lumbar interbody arthrodesis. 3,7 It was initially described by Harms in the early 1980s. 1,2 The TLIF method has become popular for achieving interbody fusion, in part by limiting the need for a second anterior approach and avoiding the risks associated with anterior lumbar surgery.There are concerns, however, about the amount of disc material that can be removed posteriorly.

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Evaluation of Efficacy of Percutanous Laser Disk Decompression and Percutanous Hydrodyscectomy in Patients with Lumbar Disc Protrusion and Bulging

“…Ablasyon için suyun yüksek yoğunluktaki akımına bir odaklanmayla kullanılır, aynı zamanda dokuyu aspire eder (12) . Kadavraları kullanan bir çalışmada, kusursuz bir prosedür olarak hızlı bir şekilde uygulanmıştır (30) . Biz çalışmamızı canlı hasta grubunda uyguladık.…”

Waterjet cutting of periprosthetic interface tissue in loosened hip prostheses: An in vitro feasibility study

“…The technique is used clinically for cutting soft tissues like liver tissue [3][4][5][6] and experimentally for dissecting spleen tissue [7,8], kidney tissue [9][10][11][12] and brain tissue [2,13,14]. Waterjets have also been investigated for cutting hard materials such as bone and bone cement [15][16][17][18].…”