Experimental Model for Interlaminar Endoscopic Spine Procedures.

Abstract

Endoscopic spinal surgery is becoming quite popular, and the pursuit of a training model to improve surgeons' skills is imperative to overcome the limited availability of human cadavers. Our goal was to determine whether the porcine spine could be a representative model for learning and practicing interlaminar percutaneous endoscopic lumbar procedures (IL-PELPs). Lumbar and cervical segments of the porcine cadaver spine were used for the IL-PELP. We have described the technical notes on the difficulties of the procedure and the relevant anatomical features. To endorse the porcine cadaver for this procedure, 5 neurosurgeons underwent 1 day of training and completed a survey. The porcine lumbar spine has small interlaminar windows, and laminectomy is necessary, mimicking the translaminar approaches for higher human lumbar spine levels. The porcine cervical spine has wide and high interlaminar windows and mimics the human L5-S1 interlaminar approach. Entering the spinal canal with the working sheath and endoscope and training the rotation maneuver to access the disc space is only possible in the lumbar segment. It was possible to perform flavectomy and to identify and dissect the dural sac and nerve root in both the lumbar and cervical spine. The neurosurgeons considered the porcine model of good operability and, although different, possible to apply in humans. The porcine spine is an effective and representative model for learning and practicing IL-PELPs. Although the described anatomical differences should be known, they did not interfere in performing the main surgical steps and maneuvers for IL-PELPs in the porcine model.