Logo image
Back
Endoscopic Transforaminal for Aminoplasty and Instability: A Cadaveric Biomechanical Model
Abstract   Peer reviewed

Endoscopic Transforaminal for Aminoplasty and Instability: A Cadaveric Biomechanical Model

Shahed Elhamdani, Vyas Praveer, Owen Corcoran, Jahan Aslami, Cody Woodhouse, Dallas E. Kramer, Coby Cunningham, Chen Xu, Alexander Yu and Boyle C. Cheng
Neurosurgery, v 72(Supplement_1), pp 255-255
Apr 2026
DOI: https://doi.org/10.1227/neu.0000000000003964_2050
Featured in Collection :   Drexel's Newest Publications

Abstract

INTRODUCTION: Transforaminal endoscopic spine surgery often involves superior articular process (SAP) resection for expansile foraminoplasty, potentially causing iatrogenic instability. Understanding the biomechanical impact of SAP resection extent is crucial for optimizing technique and preserving stability. This cadaveric study aimed to quantify these effects and is the first cadaveric study to evaluate the impact of endoscopic spine surgery on lumbar biomechanics. METHODS: Six lumbar functional spinal units (FSUs) underwent testing while intact and after each of four passes of successive unilateral resection of the SAP. Each pass performed with a 3 millimeter burr approximated one quartile of total resection. Biomechanical evaluation was performed using a pure-moment flexibility protocol (flexion-extension (FE), lateral-bending (LB) and axial torsion (AT) at +/- 7.5 Nm) using a six-degrees-of-freedom spine tester and an optoelectric tracking system (Optotrak Certus, Northern Digital, Waterloo, ON) to measure range of motion (ROM). ROM and neutral zone (NZ) were analyzed by one-way repeated-measures ANOVA (RM-ANOVA) and post-hoc comparison to intact using the paired t-test and Holm method and are reported (normalized to intact value) as mean +/- standard deviation. RESULTS: Resection of the SAP had a significant effect on LB ROM (RM-ANOVA, P = 0.017) but not on FE ROM or AT ROM. LB ROM was significantly increased from intact at each (P = 0.017) pass. Normalized LB ROM was 1.10 +/- 0.02 after the final pass. LB NZ was significantly affected by resection (RM-ANOVA, P = 0.0003), but was not significantly different in pairwise comparisons. There were marginally significant effects on AT ROM (RM-ANOVA, P = 0.059) and AT NZ (RM-ANOVA, P = 0.063). CONCLUSIONS: Resection of the SAP significantly increased motion and neutral zone in LB loading. A significant increase in LB ROM appeared with the first pass of resection. Surgeons should consider the potential for reduced stability when deciding whether or not to perform expansile foraminoplasty.

Metrics

1 Record Views

Details

InCites Highlights

Data related to this publication, from InCites Benchmarking & Analytics tool:

Web of Science research areas
Clinical Neurology
Surgery
Logo image