Comparison of bone reamer and trephine for foraminoplasty in percutaneous endoscopic lumbar discectomy based on 3D slicer and Digimizer software

Abstract Objective To explore the applicability of bone reamer and trephine for foraminoscopy in percutaneous endoscopic lumbar discectomy (PELD), and to provide a theoretical basis for foraminoplasty options in clinical practice. Methods This study was a prospective cohort study. Sixty-three consecutive patients who underwent PELD for lumbar disc herniation between May 2021 and July 2022 were analysed. Foraminoplasty were performed by bone reamer or trephine. The amount of bone removed and the foramen area enlarged during foraminoplasty by both tools were measured by 3D slicer and Digimizer software, and the numbers of fluoroscopic views were recorded. Results The bone reamer removed less bone in the Superior Articular Process (SAP) than the trephine ( t = 17.507, P < 0.001), and the area enlarged by the bone reamer was smaller than that of the trephine ( t = 10.042, P = 0.002). The overall numbers of fluoroscopic views were significantly more in the bone reamer group than in the trephine group ( t = 19.003, P < 0.001). In the bone reamer group, when the area of preoperative (FPZ) was no less than 54.55 mm 2 , the mean number of fluoroscopic views significantly decreased ( t = 14.443, P = 0.001). Conclusion Bone reamer was safer and trephine was more efficient for foraminoscopy in PELD. An area of preoperative (FPZ) of 54.55 mm 2 can be used as a critical value: bone reamer reduced the risk for cases above the value, while trephine improved the efficiency for cases less than the value.