Biportal Endoscopic Transforaminal Lumbar Interbody Fusion Using Double Cages: Surgical Techniques and Treatment Outcomes

Abstract

Objective: To describe the surgical techniques and the treatment outcomes of biportal endoscopic transforaminal lumbar interbody fusion (BETLIF) using double cages.Methods: This study included 89 patients with 114 fusion segments between July 2019 and May 2021. One pure polyetheretherketone (PEEK) cage and 1 composite titanium-PEEK cage were used for interbody fusion. Clinical outcomes measures included visual analogue scale (VAS) scores for lower back pain and leg pain, Oswestry Disability Index (ODI), and Japanese Orthopedic Association (JOA) scores. Computed tomography (CT) of the lumbar spine 1 year postoperatively was used to evaluate the Bridwell interbody fusion grades.Results: There were significant improvement in VAS for lower back pain from 5.2 ± 3.1 to 1.7 ± 2.1, VAS for leg pain from 6.3 ± 2.5 to 1.7 ± 2.0, ODI from 46.7 ± 17.0 to 12.7 ± 16.1, and JOA score from 15.6 ± 6.3 to 26.4 ± 3.2. The p-values were all < 0.001. The average hospital stay was 5.7 ± 1.1 days. The CT studies available for 60 fusion segments showed successful fusion (Bridwell grade I or grade II) in 56 segments (93.3%). Significant cage subsidence of more than 2 mm was only noted in 3 segments (5.0%). Complications included 1 dural tear, 2 pedicle screws malposition, and 2 epidural hematomas, in which 2 patients required reoperations.Conclusion: BETLIF with double cages provided good neural decompression and a sound environment for interbody fusion with a big cage footprint, a large amount of bone graft, endplate preservation, and segmental stability.

Biportal Endoscopic Trans-Kambin Lumbar Interbody Fusion: Surgical Techniques and Treatment Outcomes

“…Compared with our previous series of MIS-TLIF, BE-KLIF had a shorter operating time, less impact on hemostatic status, al-Park, and 93.7% by Kim for the use of BE-TLIF [6,7,14]. Our study involved 2 cases of cage retropulsion with nerve root impingement requiring revision surgery.…”

“…The mean duration of hospitalization was 7.1±3.0 days, which is much shorter than that for patients receiving MIS-TLIF procedures at our institute (9.1±2.7 days, 62 cases, 2015-2018). However, in other studies, the mean duration of hospitalization for patients receiving MIS-TLIF was 7.8±2.3 days [12] and for patients receiving BE-TLIF was 5.7±1.1 days [6]. These hospitalization durations may not be comparable due to factors such as In total, 16 cases were lost to follow-up after 3 months and excluded from the evaluation of fusion status.…”

“…The BE-TLIF approach was evolved from the MIS-TLIF postero-lateral approach but discarded the expandable tubular retractor and instead uses endoscopic video-guided irrigation system to sacrifice the facet joint, with a slightly oblique trajectory employed to insert one or 2 cages for interbody fusion. Several papersincluding those by Heo et al [3], Kim and Choi [4], Pao [6], and Kang et al [7]-have been published on biportal endoscopic techniques and have demonstrated the significant improvements these techniques yield compared with prior MIS-TLIF techniques. The improvements yielded by BE-TLIF techniques include early ambulation, reduced postoperative pain, and a shorter hospital stay [8].…”

The Endoscopic Lumbar Interbody Fusion: A Narrative Review, and Future Perspective

“…To enhance fusion rates, the insertion of double cages in biportal endoTLIF, which enlarges the cage footprint. This technique resulted in significantly improved clinical outcomes and excellent fusion rates, with a low incidence of cage subsidence [ 62 ]. In a prospective randomized clinical trial, the clinical and radiologic outcomes were compared between banana-shaped cages and straight cages in single-level MIS-TLIF [ 63 ].…”

Future of Endoscopic Spine Surgery: Insights from Cutting-Edge Technology in the Industrial Field

“…This comprehensive system includes various ESS techniques such as Anterior Endoscopic Cervical Discectomy (AECD) [15], Posterior Endoscopic Cervical Foraminotomy (PECF), Posterior Endoscopic Cervical Discectomy (PECD) [16], Cervical Endoscopic Unilateral Laminotomy for Bilateral Decompression (CE-ULBD) [17], Transforaminal Endoscopic Thoracic Discectomy (TETD) [18], Thoracic Endoscopic Unilateral Laminotomy for Bilateral Decompression (TE-ULBD) [19], Transforaminal Endoscopic Lumbar Discectomy (TELD) [20], Interlaminar Endoscopic Lumbar Discectomy (IELD) [21], Extraforaminal Endoscopic Lumbar Discectomy (EELD) [22], and Transforaminal Endoscopic Lumbar Foraminotomy (TELF) [23]. Additionally, techniques like Transforaminal Endoscopic Lumbar Interbody Fusion [24] and UBE Fusion [25,26] are also included. Beyond the AO Spine nomenclature, ESS is also employed in various surgeries, such as surgery for craniovertebral junction [27], spinal metastasis [28], spinal abscess [29], and far-out syndrome [30].…”