Clinical Study Of The Application Of 3D Printing Skeletal Models In Percutaneous Spinal Endoscopy

Objectives: The syudy aimed to explore the clinical significance of 3D printing technology for percutaneous endoscopic lumbar discectomy,,then provide preoperative planning for surgery new ideas and a reference for the formation of intervertebral foramen.Methods:62 cases adopting 3D printing skeletal model combined with percutaneous transforaminal endoscopic lumbar discectomy during July 2016 to October 2017 were enrolled in this retrospective study,which included 34 males and 28 females with an average age of 52.3,ranged from 32 to 67 years old.The visual analogue scale(VAS)was performed preoperatively,1 week after surgery,1 month after surgery and 3 months after surgery,respectively The clinical effect was evaluated by Machab's standard of evaluation after 3 months.At the same time,the foramen parameters of 3D printing model were established and the data of intervertebral foramen width(ab),intervertebral disc height(ac),intervertebral foramen height(de)and MN cross angle were measured.Results: All patients were followed up and all of then showed good clinical efficacy.The preoperative symptoms and signs were relieved obviously.The VAS scores of lumbago and leg pain at 1 week,1 month and 3 months after operation were lower than those before operation,and the difference was statistically significant(P <0.05).All cases were evaluated according to the modified Macnab curative effect evaluation standard,the excellent and good rate was 93.54%.The measured data for the foramina in the 3D print model varied from case to case,and there was a difference in the foramen between the left and right of each case: the ipsilateral intervertebral foramen width(ab)was 6.30 ± 1.71,the ipsilateral intervertebral disc height(ac)was 4.88± 1.63,the ipsilateral intervertebral foramen length(de)was 21.07 ± 3.78,theipsilateral MN angle was 16.28±1.13;the contralateral intervertebral foramen width(ab)was 7.27±1.86,the contralateral intervertebral disc height(ac)was 5.31±1.71,the contralateral intervertebral foramen length(de)was 18.57±3.34,the contralateral MNangle was 25.72 ± 1.03.The ipsilateral intervertebral foramina(ab),intervertebral disc height(ac)and MN angle were smaller than the contralateral ones,and there was significant difference in intervertebral foramen width(ab)and MN angle between the two groups(P <0.05).In all cases,the foramen morphology in the 3D print model was older while the intervertebral foramen width(ab),intervertebral disc height(ac),intervertebral foramen length(de)and MN angle were smaller.In all cases of 3D printing model,intervertebral foramen width(ab)of the foraminoplasty patients was 4.77±0.83,intervertebral disc height(ac)was 4.97±1.35,intervertebral foramen length(de)was 16.23±2.02 and MNangle was 11.50°±2.15;intervertebral foramen width(ab)was 7.42±1.24,intervertebral disc height(ac)was 5.19±1.88,intervertebral foramen length(de)was 16.63±1.94 and MNangle was 22.22°±4.28°of patients with no foraminoplasty;The foraminoplasty of intervertebral foramen(ab),intervertebral disc height(ac)and MN angle were less than the unformed and there was a significant difference in intervertebral foramen width(ab)and MN angle between the two groups(P <0.05).And the value of ab and MN of all the patients with foraminoplasty were less than 6.0 and 15 °,respectively.Conclusion: Using 3D printed skeletal model,precise measurement before surgery,establishment of trial passage,choice of surgical approach,and pre-evaluation of surgical difficulty have guiding significance for intraoperative operation.The use of 3D printed skeletal model combined with percutaneous transforaminal lumbar discectomy for endoscopic lumbar discectomy has a good clinical effect.The preoperative planning of 3D printed skeletal model of intervertebral foramen for the surgery of L4/5 percutaneous intervertebral foramen approach under endoscopic excision of nucleus pulposus of lumbar spine,when the measured value of width and MN were less than 6mm and 15 °,respectively,the foraminoplasty of intervertebral foramen should bre performed..Compared with the shape of the foraminoplasty of intervertebral foramen or the unformed during the percutaneous lumbar discectomy for lumbar discectomy,the foraminoplasty patients intervertebral foramen width(ab)and MN angle were less than those of unformed.