Three dimensional finite element analysis used to study the influence of the stress and strain of the operative and adjacent segments through different foraminnoplasty technique in the PELD: Study protocol clinical trial (SPIRIT Compliant)

INTRODUCTION: Percutaneous endoscopic lumbar disectomy (PELD) is one of the most popular minimally invasive techniques of spinal surgery in recent years. At present, there are 2 main surgical approaches in PELD: foraminal approach and interlaminar approach. What's more, foraminoplasty is a necessary step for both approaches. However, there are few biomechanical studies on the formation of different parts of the intervertebral foramen. The aim of this study is to explore the effects of different foraminoplasty methods on the biomechanics of the corresponding and adjacent segments of the lumbar through a 3-dimensional finite element model analysis. METHODS: We established a normal 3-dimensional finite element mode of L3 to L5, simulated lumbar percutaneous endoscopy by doing cylindrical excision of bone whose diameter was 7.5 mm on the L5 superior articular process and the L4 inferior articular process, respectively, so that we obtained 3 models: the first one was normal lumbar model, the second one was the L4 inferior articular process shaped model, and the third one was the L5 superior articular process shaped model. We compared the biomechanics of the intervertebral disc of L3/4 and L4/5 when they were in the states of forward flexion, backward extension, left and right flexion, and left and right rotation on specific loading condition. DISCUSSION: If the outcomes indicate the trial is feasible and there is evidence that one of the foraminoplasty technique may make few differences in biomechanics of corresponding lumbar intervertebral disc, we will proceed to a definitive trial to test the best way to foraminplasty, which could make biomechanical influence as little as possible. Trial Registration: Chinese Clinical Trial Registry, ChiCTR1900026973. Registered on September 27, 2019.