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Study Design: Biomechanical cadaveric study., Objective: The goal of this study was to analyze the effects of an endoscopic transpedicular approach with different drill diameters (6 and 8 mm) and compare them with the intact native side. In addition, the influence of bone quality on the resistance of the pedicle was investigated., Summary of Background Data: Clinical studies have repeatedly highlighted the benefits of endoscopic transpedicular decompression for downmigrated lumbar disc herniations. However, the biomechanical effects on pedicle stability have not been studied up to now., Materials and Methods: Twenty-four vertebras originating from four fresh-frozen cadavers were tested under uniaxial compression load in a ramp-to-failure test: (1) the tunneled pedicle on one side, and (2) the native pedicle on the other side. Twelve lumbar vertebrae were assigned to drill diameter of 6 mm and the other 12 to diameter of 8 mm., Results: The median ratio of sustained force for the operated side compared with the intact contralateral side is equal to 74% (63-88) for both drill diameters combined. An 8 mm transpedicular approach recorded an axial resistance of 77% (60-88) compared with the intact contralateral side ( P =0.002). A 6 mm approach resulted in an axial resistance of 72% (66-84) compared with the intact opposite side ( P =0.01). No significant difference between the two different drill diameters was recorded ( P =1). For all three subgroups (intact, 8 mm, 6 mm) the Hounsfield units-values and the absolute resistance force showed significant correlations (intact: ρ=0.859; P <0.001; 8 mm: ρ=0.902; P <0.001; 6 mm: ρ=0.835; P <0.001)., Conclusion: The transpedicular approach significantly reduces the axial resistance force of the pedicle, which may lead to pedicle fracture. Bone quality correlated positively with the absolute resistance force of the pedicle, whereas the influence of the drill hole diameter plays only a limited role., Competing Interests: M.F. reports being a Consultant for Incremed (Balgrist University Startup), Zimmer Biomet, Medacta, and 25 Segments (Balgrist Startup). The remaining authors report no conflicts of interest., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Study Design: Biomechanical cadaveric study., Objective: The aim of this study was to compare the effect of transforaminal endoscopic approaches with open decompression procedures., Summary of Background Data: Clinical studies have repeatedly highlighted the benefits of endoscopic decompression, however, the biomechanical effects of endoscopic approaches (with and without injury to the disk) have not been studied up to now., Materials and Methods: Twelve spinal segments originating from four fresh-frozen cadavers were biomechanically tested in a load-controlled endoscopic transforaminal approach study. Segmental range of motion (ROM) after endoscopic approach was compared with segmental ROM after (1) microsurgical decompression with unilateral laminotomy and (2) midline decompression with bilateral laminotomy. In the intact state and after decompression, the segments were loaded in flexion-extension (FE), lateral shear (LS), lateral bending (LB), anterior shear (AS), and axial rotation (AR)., Results: Vertebral segment ROM was comparable between the two endoscopic transforaminal approaches. However, there was a-statistically nonsignificant-trend for a larger ROM after accessing via the inside-out technique: FE: +3% versus +7%, P =0.484; LS: +1% versus +12%, P =0.18; LB: +0.6% versus +9%, P =0.18; AS: +2% versus +11%, P =0.31; AR: -4% versus +5%, P =0.18. No significant difference in vertebral segment ROM was seen between the transforaminal endoscopic approaches and open unilateral decompression. Vertebral segment ROM was significantly smaller with the transforaminal endoscopic approaches compared with midline decompression for almost all loading scenarios: FE: +4% versus +17%, P =0.005; AS: +6% versus 21%, P =0.007; AR: 0% versus +24%, P =0.002., Conclusion: The transforaminal endoscopic intracanal technique preserves the native ROM of lumbar vertebral segments and shows a trend toward relative biomechanical superiority over the inside-out technique and open decompression procedures., Competing Interests: The authors report no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background Context: The biomechanical impact of spondylophytes on segmental stiffness is largely unknown, despite their high incidence., Purpose: The aim of this study was to quantify the biomechanical contribution according to location and cranio-caudal extent of spondylophytes and to create a clinically applicable radiological classification system., Study Design: Biomechanical cadaveric study., Methods: Twenty-six cadaveric human lumbar spinal segments with spondylophytes were tested with a displacement-controlled stepwise reduction method. The reduction in load required for the same motion after spondylophyte dissection was used to calculate the biomechanical contribution in flexion, extension, axial rotation, lateral bending, anterior, posterior and lateral shear. The spondylophytes were categorized by assessment of their anatomical position and cranio-caudal extent in computed tomography images (grade 1: spondylophytes spanning less than 50% of the disc-height, grade 2:>50%, grade 3:>90%, grade 4: bony bridging between the vertebrae) by two experienced radiologists. Cohen's kappa (κ) was used to report interreader reliability., Results: The largest biomechanical effect of non-bridging spondylophytes (grade 1-3) was recorded during contralateral bending with a grade-dependent contribution of up to 35%. Other loading directions including ipsilateral bending and translational loading were affected with values below 13%. Spondylophytes with osseous bridging (grade 4) show large contribution to the segmental stiffness in most loading conditions with values reaching over 80%. Interreader agreement for the spondylophyte grading was "substantial" (κ=0.73, p<.001)., Conclusions: The location and cranio-caudal extent of spondylophytes are essential parameters for their biomechanical effect. A reproducible classification has been validated biomechanically and helps evaluate the effect of specific spondylophyte configurations on segmental stiffness., Clinical Significance: Non-bridging spondylophytes primarily act as tensile structures and do not provide relevant propping. A classification system is presented to support understanding of the biomechanical consequences of different spondylophyte configuration for clinical decision making in surgical planning., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

3D printed clamps provide multiple advantages compared to potting for the fixation of spinal specimens and in a recent study, superior fixation stability was reported. The aim of this study was to evaluate the fixation efficacy of 3D printed vertebra clamps during routine application and to present and evaluate a novel clamp for sacrum fixation. Further, public access to the template files is provided. 98 human single-level cadaveric specimens were biomechanically tested in flexion-extension (FE), lateral bending (LB), axial rotation (AR), anteroposterior shear (AS), lateral shear (LS) and axial compression-decompression (AC). Loading amplitudes were +/-7.5 Nm for FE, LB and AR, +/- 150 N for AS and LS and + 400/-100 N for AC. The novel sacrum clamp was used in 8 specimens. The median relative motion between clamps and specimens was 0.6° in FE, 0.7° in LB, 0.3° in AR, 0.5 mm in AS, 0.5 mm in LS and 0.1 mm in AC. With sacrum clamps, the median relative motion was 0.3° in FE, 0.1° in LB, 0.08° in AR, 0.8 mm in AS, 0.7 mm in LS and 0.2 mm in AC. The vertebra clamps used during routine testing provided better stability compared to the values in the literature in all six loading directions (p < 0.05). The sacrum clamp showed superior anchoring stability in three loading directions compared to the caudal vertebra clamps (p < 0.05), while inferior stability was measured in AS (p < 0.001). We conclude that 3D printed vertebra clamps and 3D printed sacrum clamps represent reliable methods for specimen fixation during routine biomechanical testing., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

This study presents an anatomically customizable fixation technique for biomechanical spine experiments using a 3D printed clamping system. The aim of this study is to evaluate the feasibility and compare the fixation rigidity of the novel technique to PMMA potting with and without screw augmentation. For this purpose, 16 thoracic and lumbar functional spine units of bovine, porcine, ovine and human cadavers (4 each) were consecutively fixed with all three techniques and loaded in six degrees of freedom. The combined relative movement between the cranial and caudal vertebral body and their corresponding fixtures were recorded using a 3D motion capture system. The 3D printed clamps did provide multiple advantages, showed no failures and the fixation rigidity was superior to potting in all loading directions and superior to screw-augmented potting in two of six loading directions (p < 0.05). In conclusion, the here proposed novel fixation method showed equal to superior properties in comparison to both other methods used in this study. When considering all characteristics of 3D printing, 3D printed fixtures can be an effective alternative to potting., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Spinal stenosis can be found in up to 80 % of individuals aged over 70 years. However, about 20 % of asymptomatic individuals demonstrate signs of spinal stenosis on MRI. The pathomechanism of central spinal stenosis is predominantly related to degenerative changes. Those eventually result in a progressive compression of the cauda equina. Patients who exhibit mild to moderate symptoms should undergo multimodal conservative treatment, such as patient education, pain medication, physiotherapy and epidural injections. Surgery should be evaluated in patients with severe symptoms, especially if conservative treatment fails after 3–6 months of trial. Clinically relevant motoric deficits or symptoms of cauda equina syndrome remain absolute indications for surgery.