Methods and Early Clinical Results of Percutaneous Lumbar Interbody Fusion

Nakamura, Shu; Ito, Fjio; Ito, Zenya; Shibayama, Motohide

doi:10.14245/ns.2040302.151

Cited by 11 publications

(4 citation statements)

References 30 publications

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“…In this study, only one case of cage subsidence occurred, and the incidence rate was far lower than that in previous studies related to endoscopic lumbar fusion. However, the fusion rate of the enrolled cases was 93.5% one year after operation, which was similar to the previous research results of lumbar fusion using other surgical methods ( 17 , 18 ). These results suggest that the fusion effect of PCLE-LIF is satisfactory.…”

Section: Discussionsupporting

confidence: 88%

Analysis of curative effect of percutaneous coaxial large channel endoscopic lumbar interbody fusion in the treatment of degenerative lumbar spinal stenosis

et al. 2022

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ObjectiveTo investigate the clinical efficacy and technical points of Percutaneous Coaxial Large-channel Endoscopic Lumbar Interbody Fusion (PCLE-LIF) in the treatment of degenerative lumbar spinal stenosis.MethodsThe clinical data of patients with single-segment degenerative lumbar spinal stenosis who underwent PCLE-LIF surgery from January 2019 to June 2021 were retrospectively analyzed. Surgery-related data included symptom duration, operation time, hospital stay, and complication rate. Functional score data included low back pain and lower extremity pain VAS score, ODI score, and MacNab criteria were used to evaluate clinical effects. The Brantigan criteria were used to evaluate the interbody fusion.ResultsThere were 62 patients in this group, including 35 males and 27 females. The surgical sites were all lower lumbar spine, including 35 cases of lumbar L4/5 and 27 cases of L5/S1. The length of hospital stay was 7.7 ± 1.4 days. All patients were followed up regularly for 1 year. The interbody fusion rate was 93.5% at 1 year after operation. There were 2 cases of numbness, 2 cases of nerve edema and pain, 1 case of cage displacement, and 1 case of pedicle screw loosening. The complication rate was 9.6%. The VAS scores of low back pain 1 day before surgery, 3 days, 3 months and 1 year after surgery were 4.48 ± 1.06, 0.84 ± 0.81, 0.40 ± 0.56, 0.39 ± 0.69, and the VAS of lower extremity pain at each time point of appeal were 5.58 ± 0.98, 0.91 ± 0.58, 0.31 ± 0.46, 0.19 ± 0.40. The ODI scores at 1 day before surgery, 3 months and 1 year after surgery were 60.01 ± 6.21, 15.58 ± 2.84, 8.82 ± 2.15. The ODI scores and VAS scores of low back pain and lower extremity pain at each follow-up time point after operation were significantly lower than those before operation (p < 0.05). The 1-year follow-up after operation was evaluated by the modified MacNab standard, and the results were excellent in 36 cases, good in 23 cases, fair in 3 cases, and poor in 0 cases, with an excellent and good rate of 95.2%.ConclusionPercutaneous coaxial large-channel endoscopic lumbar interbody fusion in the treatment of degenerative lumbar spinal stenosis has good short-term efficacy and high safety, and is worthy of popularization.

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Section: Discussionsupporting

confidence: 88%

Analysis of curative effect of percutaneous coaxial large channel endoscopic lumbar interbody fusion in the treatment of degenerative lumbar spinal stenosis

et al. 2022

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“…Japan has a similar national health insurance system to that of the ROK and there are many active endoscopic surgeons in Japan [ 44 ]. Japan also shares the issue of practical reimbursement for endoscopic spine surgery, which requires supplies such as endoscopes, endoscopic drills, and electrode [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Cost-utility analysis of endoscopic lumbar discectomy following a uniform clinical pathway in the Korean national health insurance system

et al. 2023

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Introduction Full-endoscopic lumbar discectomy (FELD) is a type of minimally invasive spinal surgery for lumbar disc herniation (LDH). Sufficient evidence exists to recommend FELD as an alternative to standard open microdiscectomy, and some patients prefer FELD due to its minimally invasive nature. However, in the Republic of Korea, the National Health Insurance System (NHIS) controls the reimbursement and use of supplies for FELD, but FELD is not currently reimbursed by the NHIS. Nonetheless, FELD has been performed upon patients’ request, but providing FELD for patients’ sake is inherently an unstable arrangement in the absence of a practical reimbursement system. The purpose of this study was to conduct a cost-utility analysis of FELD to suggest appropriate reimbursements. Method This study was a subgroup analysis of prospectively collected data including 28 patients who underwent FELD. All patients were NHIS beneficiaries and followed a uniform clinical pathway. Quality-adjusted life years (QALYs) were assessed with a utility score using the EuroQol 5-Dimension (EQ-5D) instrument. The costs included direct medical costs incurred at the hospital for 2 years and the price of the electrode ($700), although it was not reimbursed. The costs and QALYs gained were used to calculate the cost per QALY gained. Result Patients’ mean age was 43 years and one-third (32%) were women. L4-5 was the most common surgical level (20/28, 71%) and extrusion was the most common type of LDH (14, 50%). Half of the patients (15, 54%) had jobs with an intermediate level of activity. The preoperative EQ-5D utility score was 0.48±0.19. Pain, disability, and the utility score significantly improved starting 1 month postoperatively. The average EQ-5D utility score during 2 years after FELD was estimated as 0.81 (95% CI: 0.78–0.85). For 2 years, the mean direct costs were $3,459 and the cost per QALY gained was $5,241. Conclusion The cost-utility analysis showed a quite reasonable cost per QALY gained for FELD. A comprehensive range of surgical options should be provided to patients, for which a practical reimbursement system is a prerequisite.

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“…9 Nakamura et al described uniportal facet-preserving trans-Kambin endoscopic fusion using a standard transforaminal lumbar interbody fusion (TLIF) cage and a modified retractor system. 10 Several other authors have described similar endoscopic fusion through Kambin's triangle over the past 2 decades, using various terminology such as percutaneous transforaminal endoscopic lumbar interbody fusion, 11,12 percutaneous endoscopic TLIF, [13][14][15] full endoscopic lumbar interbody fusion, 16 full endoscopic TLIF, 17 and LEW-LIF. 9 All the various nomenclature involved insertion of an interbody cage through Kambin's triangle using a transforaminal endoscopic approach and fluoroscopic assistance.…”

Section: Evolution Of Uniportal Endoscopic Interbody Fusion Uniportal Facet-preserving Trans-kambin Endoscopic Fusionmentioning

confidence: 99%

“…Inherent donor site morbidity and possible complications are associated with this technique. 10 Complications Specific to Uniportal Facet-Sacrificing Posterolateral TLIF Uniportal facet-sacrificing posterolateral TLIF is performed in close proximity to the traversing nerve root, and thus retraction of the traversing nerve root medially is often required to generate a better angle and create more working space for interbody cage insertion. Incidental durotomy and injuries to the traversing nerve root are a possible complication related to this approach.…”

Section: General Complications Of Spinal Fusionmentioning

confidence: 99%

A Narrative Review of Uniportal Endoscopic Lumbar Interbody Fusion: Comparison of Uniportal Facet-Preserving Trans-Kambin Endoscopic Fusion and Uniportal Facet-Sacrificing Posterolateral Transforaminal Lumbar Interbody Fusion

Kim

Sairyo

et al. 2021

Int J Spine Surg

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Uniportal endoscopic lumbar interbody fusion aims to achieve the bony union of 2 lumbar segments through cage insertion using full spinal endoscopy. Endoscopic fusion can adjust foraminal height and disc height, improve alignment, and minimize collateral soft tissue damage during the insertion of an interbody cage. The surgery is performed under constant irrigation with normal saline and an optical endoscopic lens close to the targeted disc segment. Two main subtypes of uniportal endoscopic fusion are currently described in the literature. We broadly classify them into facet-preserving and facet-sacrificing endoscopic lumbar interbody fusions. We have termed them uniportal facet-preserving trans-Kambin endoscopic fusion and uniportal facetsacrificing posterolateral transforaminal lumbar interbody fusion. In this article, we review the current literature and discuss the history, indications, contraindications, technical differences, clinical outcomes, and complications of uniportal endoscopic interbody fusion surgery.

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Methods and Early Clinical Results of Percutaneous Lumbar Interbody Fusion

Cited by 11 publications

References 30 publications

Analysis of curative effect of percutaneous coaxial large channel endoscopic lumbar interbody fusion in the treatment of degenerative lumbar spinal stenosis

Analysis of curative effect of percutaneous coaxial large channel endoscopic lumbar interbody fusion in the treatment of degenerative lumbar spinal stenosis

Cost-utility analysis of endoscopic lumbar discectomy following a uniform clinical pathway in the Korean national health insurance system

A Narrative Review of Uniportal Endoscopic Lumbar Interbody Fusion: Comparison of Uniportal Facet-Preserving Trans-Kambin Endoscopic Fusion and Uniportal Facet-Sacrificing Posterolateral Transforaminal Lumbar Interbody Fusion

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