Uniportal Full Endoscopic Posterolateral Transforaminal Lumbar Interbody Fusion with Endoscopic Disc Drilling Preparation Technique for Symptomatic Foraminal Stenosis Secondary to Severe Collapsed Disc Space: A Clinical and Computer Tomographic Study with Technical Note

Abstract

Background: Severe collapsed disc secondary to degenerative spinal conditions leads to significant foraminal stenosis. We hypothesized that uniportal posterolateral transforaminal lumbar interbody fusion with endoscopic disc drilling technique could be safely applied to the collapsed disc space to improve patients’ pain score, restore disc height, and correct the segmental angular parameters. Methods: We included patients who met the indication criteria for lumbar fusion and underwent uniportal full endoscopic posterolateral transforaminal lumbar interbody fusion with pre-operative Computer Tomography mid disc height of less than or equal to 5 mm and MRI of Grade 3 Foraminal Stenosis. Visual analogue scale and computer tomography pre-operative and post-operative sagittal disc height in the anterior, middle and posterior part of the disc; sagittal focal segmental angle; mid coronal disc height and coronal wedge angles were evaluated. Results: 30 levels of Endo-TLIF were included, with a mean follow up of 12 months. The mean improvement in decreasing pain score was 2.5 ± 1.1, 3.2 ± 0.9 and 4.3 ± 1.0 at 1 week post operation, 3 months post operation and at final follow up, respectively, p < 0.05. There was significant increase in mid sagittal computer tomographic anterior, middle and posterior disc height of 6.99 ± 2.30, 6.28 ± 1.44, 5.12 ± 1.79 mm respectively, p < 0.05. CT mid coronal disc height showed an increase of 7.13 ± 1.90 mm, p < 0.05. There was a significant improvement in the CT coronal wedge angle of 2.35 ± 4.73 and the CT segmental focal sagittal angle of 1.98 ± 4.69, p < 0.05. Conclusion: Application of Uniportal Endoscopic Posterolateral Lumbar Interbody Fusion in patients with severe foraminal stenosis secondary to severe collapsed disc space significantly relieved patients’ pain and restored disc height without early subsidence or exiting nerve root dysesthesia in our cohort of patients.

A Narrative Review of Development of Full-Endoscopic Lumbar Spine Surgery

“…A large autografted titanium 3-dimensional-printed cage can be inserted under regional anesthesia while sedation is monitored safely. In the authors’ experience, having a larger working area allowed placement of a larger interbody cage and hence necessitated an expandable cage [ 95 ]. They demonstrated the technique in the treatment of a patient with grade 2 spondylolisthesis and instability [ 93 ].…”

“…In the authors' experience, having a larger working area allowed placement of a larger interbody cage and hence necessitated an expandable cage. 95 They demonstrated the technique in the treatment of a patient with grade 2 spondylolisthesis and instability. 93 There is little literature on posterolateral transforaminal endoscopic lumbar interbody fusion.…”

The technical feasibility and preliminary results of minimally invasive endoscopic-TLIF based on electromagnetic navigation: a case series

“…Wenjie Wu compared the application of Endo-TLIF with MIS-TLIF for the treatment of lumbar degenerative disease; they found that Endo-TLIF was effective for patients with single-segment lumbar degenerative diseases, and it was characterized by minor injury, quicker recovery, and lower cost [ 17 ]. Pang Hung Wu revealed that uniportal endoscopic posterolateral lumbar interbody fusion was feasible in the treatment of severe foraminal stenosis secondary to severe collapsed disc space, where the VAS score decreased 4.3 ± 1.0 at the last follow-up, and disc height was restored significantly [ 18 ]. In our study, the VAS score and ODI of the 42 patients decreased from 7.51 ± 1.91 and 82.42 ± 8.7% to 2.09 ± 0.59 and 11.09 ± 3.2%, respectively, and the clinical symptoms improved significantly at the last follow-up.…”

Anesthesia For Endoscopic Spine Surgery Of The Spine In An Ambulatory Surgery Center

“…In comparision, the majority of spinal endoscopies are percutaneous posterior procedures with neglible blood loss, minimal muscle dissection, and hardly any postoperative wound pain. These posterior transforaminal or interlaminar decompression procedures seem preferred by most endoscopic spine surgeons for greater versatility, simplicity, and lower risks to the vital structures in the spine [49][50][51][52][53][54][55][56][57][58].…”