Centrifuge trephine-guided foraminoplasty in endoscopic lumbar discectomy: a laboratory and clinical evaluation.

OBJECTIVES

Accurate placement of the working cannula during foraminoplasty remains a technical challenge in percutaneous transforaminal endoscopic lumbar discectomy (TELD). To address this, we developed a novel centrifuge trephine system designed to improve placement accuracy and provide a self-correcting trajectory. This study aimed to compare its performance with that of conventional trephine systems.

METHODS

This investigation comprised a laboratory simulation and a retrospective clinical study. In the laboratory, life-size 3D-printed lumbar models were used to compare operative time, fluoroscopic exposure, and cannula-to-herniation distance between the modified and conventional systems. Clinically, 101 patients with at least one year of follow-up were analyzed. Outcome measures included operative time, fluoroscopy times, cannula-herniation distance, postoperative dysesthesia, visual analog scale (VAS) scores for leg and back pain, Oswestry Disability Index (ODI), re-herniation, and reoperation rates. Statistical analyses were performed using the Mann-Whitney U test for continuous variables and the χ2 test for categorical variables.

RESULTS

The modified system significantly reduced operative time and fluoroscopy exposure in both laboratory and clinical settings (P < 0.001). Clinically, it also resulted in a shorter cannula-to-herniation distance (P < 0.05) and lower postoperative back pain VAS scores (P = 0.0004), with no cases of dysesthesia. There were no significant differences in leg pain VAS, ODI, re-herniation, or reoperation rates between groups.

CONCLUSIONS

The centrifuge trephine system demonstrated superior accuracy and efficiency compared to the conventional trephine, and was associated with improved clinical outcomes. It may be an alternative to conventional foraminoplasty techniques in TELD procedures.