A modified percutaneous transforaminal endoscopic surgery for central calcified thoracic disc herniation at the T11/T12 level using foraminoplasty and decompression - A case report
At a Glance
Section titled âAt a Glanceâ| Metadata | Details |
|---|---|
| Publication Date | 2023-05-09 |
| Journal | Frontiers in Surgery |
| Authors | Hou Lisheng, Tian Suhuai, Dong Zhang, Qing Zhou |
| Institutions | Chinese PLA General Hospital |
| Citations | 2 |
| Analysis | Full AI Review Included |
6CCVD Technical Documentation: MPCVD Diamond for High-Precision Endoscopic Spine Surgery
Section titled â6CCVD Technical Documentation: MPCVD Diamond for High-Precision Endoscopic Spine SurgeryâReference Paper: Lisheng H, Suhuai T, Dong Z and Qing Z (2023) A modified percutaneous transforaminal endoscopic surgery for central calcified thoracic disc herniation at the T11/T12 level using foraminoplasty and decompression: A case report. Front. Surg. 10:1084485.
Executive Summary
Section titled âExecutive SummaryâThis research demonstrates the successful application of a modified percutaneous transforaminal endoscopic surgery (PTES) technique for treating Central Calcified Thoracic Disc Herniation (CCTDH), a procedure critically dependent on advanced diamond tooling.
- Application Focus: Minimally Invasive Spine Surgery (MISS) for the safe and complete removal of highly calcified tissue (CCTDH) at the T11/T12 level.
- Critical Tooling: The procedure relied on a flexible endoscopic power diamond drill to thin and degrade the hard calcified shell under high-speed rotation (up to 25,000 r/min).
- Material Requirement: The extreme hardness and wear resistance of MPCVD diamond are essential to safely ablate calcified bone while minimizing risk to the fragile dural sac (the âno-touch techniqueâ).
- Clinical Outcome: The modified PTES resulted in excellent patient recovery, with the mJOA score improving from 12 preoperatively to 18 at the 2-year follow-up.
- 6CCVD Value Proposition: We supply high-quality, custom MPCVD Polycrystalline Diamond (PCD) plates, ideal for manufacturing robust, high-performance surgical burrs and drills required for this technically demanding procedure.
- Customization: 6CCVD offers custom dimensions (up to 125mm PCD) and specialized metalization services necessary for integrating diamond components into flexible endoscopic surgical systems.
Technical Specifications
Section titled âTechnical SpecificationsâThe following hard data points were extracted, highlighting the operational demands placed on the diamond tooling and the clinical success achieved.
| Parameter | Value | Unit | Context |
|---|---|---|---|
| Tool Type | Flexible Endoscopic Power Diamond Drill | N/A | Used for thinning the calcified shell |
| Maximum Rotation Speed | 25,000 | r/min | High-speed requirement for calcified tissue degradation |
| Maximum Flexible Angle | 30 | ° | Distal end articulation for precise maneuvering |
| Preoperative mJOA Score | 12 | Points | Modified Japanese Orthopedic Association score |
| 3-Month Postoperative mJOA Score | 17 | Points | Significant functional improvement |
| 2-Year Postoperative mJOA Score | 18 | Points | Complete recovery and symptom alleviation |
| Early-Stage Trephine Diameter | 7.5 | mm | Used for fluoroscopic foraminoplasty |
| Trephine Penetration Depth | 5-8 | mm | Into the Superior Articular Process (SAP) |
| Operation Time | 100 | min | Total duration of the modified PTES procedure |
| Dural Sac Protection Method | No-touch technique | N/A | Required high-precision, controlled diamond ablation |
Key Methodologies
Section titled âKey MethodologiesâThe modified PTES technique relies on a multi-stage approach, where the flexible diamond drill plays a crucial role in the decompression phase.
- Target Identification: Patient placed prone; target disc (T11/T12) and skin entrance point (Guâs point, 6 cm from midline) confirmed via C-arm fluoroscopy.
- Fluoroscopic Foraminoplasty: Initial bone removal performed using a 7.5 mm hand trephine to penetrate the ventral bone of the Superior Articular Process (SAP) (5-8 mm depth).
- Endoscopic Foraminoplasty: Full endoscopic visualization used to achieve adequate foramen enlargement safely, preventing damage to neural structures.
- Decompression (Inside-Out Technique): Soft disc fragments ventral to the calcified shell were removed to create a cavity.
- Calcified Shell Degradation: A flexible endoscopic power diamond drill was introduced into the cavity.
- The drill was operated at up to 25,000 r/min.
- The drillâs 30° flexible angle and the âjoystick techniqueâ were used to thin the calcified shell (Figure 2I).
- The âno-touch techniqueâ was employed, relying on the diamondâs precision to thin the shell until it was semitransparent or totally transparent, ensuring dural sac safety.
- Final Removal: A curved dissector or flexible radiofrequency probe dissected the thinned bony shell from the dura, allowing the shell to be fractured and removed piece by piece.
6CCVD Solutions & Capabilities
Section titled â6CCVD Solutions & CapabilitiesâThe successful execution of this complex surgical procedure hinges on the reliability and performance of the diamond tooling. 6CCVD is uniquely positioned to supply the advanced MPCVD diamond materials required by manufacturers of next-generation endoscopic surgical instruments.
Applicable Materials
Section titled âApplicable MaterialsâTo replicate or extend this research, surgical tool manufacturers require diamond materials optimized for high-speed, high-wear environments.
| Material Grade | Application Suitability | 6CCVD Capability Match |
|---|---|---|
| Polycrystalline Diamond (PCD) | Ideal for robust, bulk material removal tools (burrs, drills) requiring high toughness and isotropic wear resistance against calcified bone. | We offer PCD plates up to 125mm in diameter and thicknesses up to 500”m, suitable for large-scale tool fabrication. |
| Single Crystal Diamond (SCD) | Suitable for ultra-fine cutting edges or specialized optical components within the endoscope system where surface roughness (Ra < 1nm) is critical. | We provide SCD plates from 0.1”m to 500”m thick, with industry-leading polishing (Ra < 1nm). |
| Boron-Doped Diamond (BDD) | Potential for integrated electrochemical sensing or high-stability electrode components within the radiofrequency probe used for dissection. | Custom BDD films available for specialized electrochemical applications. |
Customization Potential
Section titled âCustomization PotentialâThe flexible endoscopic power diamond drill used in this study is a highly specialized instrument. 6CCVD supports the development of similar custom tools through comprehensive material engineering services:
- Custom Dimensions: We provide diamond plates and wafers cut to specific geometries required for miniaturized endoscopic burr heads, ensuring optimal fit and performance within the working cannula.
- Advanced Metalization: Secure bonding of the diamond component to the flexible metal drill shaft is critical. 6CCVD offers internal metalization capabilities, including Ti, W, Pt, Au, Pd, and Cu layers, optimized for robust brazing and adhesion in demanding surgical environments.
- Precision Polishing: We guarantee polishing standards of Ra < 5nm for inch-size PCD, minimizing friction and ensuring smooth, controlled material ablation during high-speed operation (25,000 r/min).
Engineering Support
Section titled âEngineering SupportâThe technical challenges inherent in CCTDH removalâspecifically the need to degrade hard calcification adjacent to the dural sacâdemand precise material selection. 6CCVDâs in-house PhD team specializes in diamond material science and can assist surgical device engineers with:
- Optimizing PCD grain size and thickness for maximum wear resistance in high-RPM bone drilling applications.
- Designing custom metalization stacks to ensure thermal stability and mechanical integrity of the diamond-to-metal bond under high operational stress.
- Material consultation for similar Minimally Invasive Spinal Surgery (MISS) projects requiring ultra-hard, biocompatible components.
Call to Action: For custom specifications or material consultation regarding high-performance diamond components for surgical tooling, visit 6ccvd.com or contact our engineering team directly. We offer global shipping (DDU default, DDP available) to meet your manufacturing timelines.
View Original Abstract
Background Thoracic disc herniation (TDH) is uncommon. Central calcified TDH (CCTDH) is even rare. Traditional open surgery was considered a gold standard to treat CCTDH, but it was accompanied by a high risk of complications. Recently, a technique called percutaneous transforaminal endoscopic decompression (PTED) was adopted to treat TDH. Gu et al. designed a simplified PTED technique and named it percutaneous transforaminal endoscopic surgery (PTES) to treat various types of lumbar disc herniation; it offered the advantages of simple orientation, easy puncture, reduced steps, and little x-ray exposure. However, PTES to treat CCTDH has not been reported in the literature. Methods Here, we describe the case of a patient with CCTDH treated with a modified PTES through the unilateral posterolateral approach under local anesthesia and conscious sedation by using a flexible power diamond drill. First, we report that the patient was treated with PTES with later-stage endoscopic foraminoplasty, with an inside-out technique employed at the initial endoscopic decompression stage. Results A 50-year-old male with progressive gait disturbance and bilateral leg rigidity with paresis and numbness was diagnosed with CCTDH at the T11/T12 level on MRI and CT examinations. A modified PTES was performed on November 22, 2019. The total mJOA (modified Japanese Orthopedic Association) score preoperatively was 12. The method of the determination of incision and the soft tissue trajectory establishment process were the same as those in the original PTES technique. The foraminoplasty process was divided into initial fluoroscopic and final endoscopic stages. At the fluoroscopic stage, the hand trephineâs saw teeth were just rotated into the lateral portion of the ventral bone from the superior articular process (SAP) to seize the SAP firmly, while at the endoscopic stage, in order to remove the ventral bone from the SAP safely under direct endoscopic visualization, adequate foramen enlargement was achieved without causing any risk of damage to the neural structures in the spinal canal. During the endoscopic decompression process, the soft disc fragments ventral to the calcified shell were undermined to form a cavity using an inside-out technique. Then, a flexible endoscopic diamond burr was introduced to degrade the calcified shell, and a curved dissector or a flexible radiofrequency probe was used to dissect the thin bony shell from the dural sac. Eventually, the shell was fractured within the cavity piece by piece to remove the whole CCTDH and achieve adequate dural sac decompression, resulting in minimal blood loss and no complications. The symptoms were gradually alleviated and the patient almost completely recovered at the 3-month follow-up, with no symptom recurrence found at the 2-year follow-up. The mJOA score improved to 17 at the 3-month follow-up and to 18 at the 2-year follow-up compared with 12 points preoperatively. Conclusions A modified PTES may be an alternative minimally invasive technique for the treatment of CCTDH and provide similar or better outcomes over traditional open surgery. However, this procedure requires good endoscopic experience on the part of the surgeon and is beset with technical challenges and therefore should be performed with utmost care.
Tech Support
Section titled âTech SupportâOriginal Source
Section titled âOriginal SourceâReferences
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