Clinical and radiological outcomes of spinal endoscopic discectomy–assisted oblique lumbar interbody fusion: preliminary results

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Direct neural decompression cannot be achieved by performing lateral lumbar interbody fusion (LLIF). To overcome the indirect decompressive effect of LLIF, additional endoscopic discectomy with oblique lumbar interbody fusion (OLIF) has been attempted. The purpose of this study was to assess the clinical and radiological outcomes of patients who underwent OLIF with additional endoscopic discectomy.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>Spinal endoscopic discectomy–assisted OLIF was attempted to remove herniated disc material. Only patients with a follow-up time that exceeded 12 months were enrolled. Clinical parameters examined were the Oswestry Disability Index and visual analog scale scores of back and leg pain. Postoperative MRI was also performed.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Fourteen patients were enrolled. Central and foraminal disc herniations were evident in 8 and 6 patients, respectively. Concomitant central or foraminal herniated discs were removed completely after additional endoscopic discectomy, and disc removal was confirmed by postoperative MRI. Mean preoperative visual analog scale scores and Oswestry Disability Index scores improved postoperatively.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>OLIF with additional endoscopic discectomy results in successful direct neural decompression without posterior decompressive procedures. Endoscopic assistance might overcome the limitations of LLIF.</jats:p></jats:sec>

Preliminary clinical and radiographic outcomes of oblique lateral interbody fusion combined with percutaneous transforaminal endoscopic discectomy for degenerative lumbar disease accompanied by prolapsed disc herniation

“…8−11 Compared with transforaminal lumbar interbody fusion (TLIF) or posterior lumbar interbody fusion (PLIF), OLIF can maximally preserve posterior structures, including ligamentous structures, muscle and facet joints, however, OLIF does not access to spinal canal and the resulting indirect decompression is a drawback and restricts the application of OLIF, expecially for lumbar degenerative disease accompanied by prolapsed disc herniation or severe lumbar spinal stenosis, which are contraindications of OLIF. 12,13 For the above situations, surgeons always choose traditional TLIF or PLIF for direct decompression. However, the risk of substantial bleeding, direct neural injury, epidural adhesion, and posterior ligamentous injury are disadvantages of TLIF and PLIF.…”

“…12 However, the indications for OLIF might be extended when it combined with the assistance of spinal endoscopic discectomy, that direct decompression for intervertebral foramen or spinal canal would be realized. 12,13 So far, spinal endoscopic discectomy-assisted OLIF has been rarely reported and there are several limitations in previous studies. 12−14 In present study, we retrospectively analyzed 15 patients who had degenerative lumbar spondylolisthesis, lumbar spine instability or lumbar spinal stenosis accompanied by prolapsed disc herniation, and receieved treatment of OLIF combined with percutaneous transforaminal endoscopic discectomy (PTED).…”

Endoscope-assisted Oblique Lumbar Interbody Fusion L5-S1 with Posterior Fixation with Cortical Bone Trajectory Screw Plus Pedicle Screw for Treatment of Adjacent Segment Degeneration Disease: A Technical Note

“…Some authors suggested using direct decompression in case of spinal stenosis with the concomitant herniated lumbar disc 9) . The additional of endoscopic discectomy could directly decompress neural element without the needs of posterior decompression 6) . Another advantage of endoscopic-assisted OLIF is an ability to directly visualized the quality of end plate preparation with 30 degrees endoscopic lens 6) .…”

“…The additional of endoscopic discectomy could directly decompress neural element without the needs of posterior decompression 6) . Another advantage of endoscopic-assisted OLIF is an ability to directly visualized the quality of end plate preparation with 30 degrees endoscopic lens 6) . Because OLIF was done in right lateral decubitus position with approach from the left, central and right side pathology may be easier to reach with endoscopic assisted.…”

“…Anterior lumbar interbody fusion (ALIF) or oblique lumbar interbody fusion (OLIF) could achieve indirect decompression without operating in the scarred area but may have the limitation in case of a concurrent herniated disc. Spinal endoscopy could enhance the visual field and facilitate herniated disc removal in case of ASDis with migrated lumbar disc herniation (LDH) 6) . The double trajectory of cortical bone trajectory (CBT) screw and pedicle screw in the same pedicle can be done to avoid the necessity to remove previous instruments 4,16) .…”