Percutaneous Endoscopic Lumbar Interbody Fusion: Technical Note and Preliminary Clinical Experience with 2-Year Follow-Up

Abstract

Objective Endoscopic surgeries have been attempted in the field of lumbar decompression and fusion surgery in the past decade. Percutaneous endoscopic lumbar interbody fusion (PELIF) is a new-emerging technique taking advantages of an anatomical (Kambin's triangle) to achieve simultaneous decompression and fusion under endoscopic visualization. The purpose of this study is to evaluate the feasibility and safety of PELIF technique with general anesthesia and neuromonitoring. Methods The authors present the details of PELIF technique with general anesthesia and neuromonitoring. The first 7 consecutive patients treated with minimum of 2 year's follow-up were included. Clinical outcomes were assessed by visual analog scale (VAS) for back and leg pain, Oswestry Disability Index (ODI) scores, and the Short Form-36 health survey questionnaire (SF-36) in the immediate preoperative period and during the follow-up period. Results All patients underwent single-level PELIF surgery successfully and without conversion to open surgery. The average age was 56.0±13.0 years. All patients had Grade I degenerative/isthmic spondylolisthesis and 4 patients coexisted with disc herniation. The mean operative time was 167.5±30.9 minutes, and intraoperative blood loss was 70.0±24.5 ml. Postoperative drainage volume was 24.5±18.3 ml. The differences in the VAS scores for low back pain and leg pain between preoperative and follow-up were significant (P<0.05). The SF-36 Physical Component Summary (PCS) improved from 38.83±4.17 to 55.67±2.58 (P<0.001). The SF-36 Mental Component Summary (MCS) improved from 43.83±3.13 to 57.50±5.36 (P=0.001). The ODI score improvement rate was 33.7±3.7 %. All cases demonstrated radiopaque graft in the intervertebral disc space consistent with solid arthrodesis. Conclusions PELIF technique seems to be a promising surgical technique for selected appropriate patients, with the minimal invasive advantages in decreased blood, shortage of ambulation time, and hospital stay, compared with MIS-TLIF. Because of limited Kambin's triangle space and the exiting nerve root nearby, PELIF is still a challenging technique. Future advancement and development in instrument and cage design are vital for application and popularization of this technique. Prospective, randomized, controlled studies with large sample size on PELIF technique are still needed to prove its safety, efficacy, and minimal invasive advantages.

Comparison of Early Outcomes between Percutaneous Endoscopic and Minimally Invasive Transforaminal Lumbar Interbody Fusion for Lumbar Spondylolisthesis

“…Nerve root injury is one of the most serious complications of spinal surgery, so to protect nerve roots, we must pay great attention before each step in the procedure that may result in damage. Foraminoplasty is a necessary step for enlarging the foramen in order to provide su cient space for subsequent procedures and eliminate exiting root injury [19]. Similar to the PELD technique, the nerve root can be protected by a working tube with a beveled tip from trepan cutting and cage implantation.…”

“…Recently, the percutaneous endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) technique was reported to address a variety of spinal disorders by using endoscopic and expandable cages through Kambin's triangle [19,20]. Endo-TLIF technique was derived from the percutaneous endoscopic lumbar discectomy (PELD) technique and combined endoscopic visualization, expandable cage technology, and interbody fusion technique [21].…”

The feasibility for a novel minimally invasive surgery–percutaneous endoscopic transforaminal lumbar interbody fusion (PE-TLIF) for the treatment of lumbar degenerative diseases: a cadaveric experiment

“…And then, Jacquot et al demonstrated that the complication rate was up to 36% via endoscopic lumbar interbody fusion, and they believed that technical improvements were necessary [12]. After that, in order to decrease the complication rate, several researchers began to design and improve the endoscopic lumbar interbody fusion and related surgical instruments [11][12][13][14][15][16][17][18][19]. Most of studies showed that the endoscopic lumbar fusion technique could be a promising treatment for lumbar degenerative diseases.…”

“…Jacquot et al believed that it was necessary to make decisive technical improvements to decrease the complication rate via endoscopic fusion surgeries [12]. With the advancement of endoscopic fusion techniques, some researchers have reported satisfactory outcomes through endoscopic surgery, but the learning curve of these techniques was relatively long [14,15]. Hence, we developed a percutaneous endoscopic transforaminal lumbar interbody fusion (PE-TLIF) technique.…”

Percutaneous endoscopic posterior lumbar interbody fusion(PEPLIF): technical note

“…More oblique access to the disc could allow for adequate neural decompression and insertion of a cage with removal of less than 50% of the facet bone [11]. Wu J et al [12] were the rst to perform a traditional PELD procedure. After primary disc removal and nerve root decompression, the working tube was withdrawn, replaced with a working tube (15 or 18 mm in diameter), and an autogenous bone graft from the superior articular process and a commercially available cancellous bone allograft was placed into the interbody space.…”