Endoscopic transforaminal lumbar interbody fusion without general anesthesia: technical innovations and outcomes

Kolcun, John Paul G.; Brusko, G. Damian; Wang, Michael Y.

doi:10.21037/atm.2019.07.92

Cited by 31 publications

(23 citation statements)

References 15 publications

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“…Interbody procedures with cage insertion are essential for lumbar fusion surgery, and techniques for interbody procedure have advanced over time [ 2 , 3 , 4 , 5 ]. Conventionally, cage insertion via the transforaminal route after a posterior approach (transforaminal lumbar interbody fusion, TLIF) has been the gold-standard procedure for interbody fusion; however, the procedure has several drawbacks, including neural injury, endplate violation, cage subsidence, cage migration, and other critical problems [ 3 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ].…”

Section: Introductionmentioning

confidence: 99%

Transforaminal Lumbar Interbody Fusion (TLIF) versus Oblique Lumbar Interbody Fusion (OLIF) in Interbody Fusion Technique for Degenerative Spondylolisthesis: A Systematic Review and Meta-Analysis

Lee

Kim

Choo

et al. 2021

Life

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Preoperative pathology requiring fusion surgery has a great impact on postoperative outcomes. However, the previous clinical and meta-analysis studies did not control for the pathology. In this systematic review, the authors aimed to compare oblique lumbar interbody fusion (OLIF) with transforaminal interbody fusion (TLIF) as an interbody fusion technique in lumbar fusion surgery for patients with degenerative spondylolisthesis (DS). We systematically searched for relevant articles in the available databases. Among the 3022 articles, three studies were identified and met the inclusion criteria. In terms of radiological outcome, the amount of disc height restoration was greater in the OLIF group than in the TLIF group, but there was no significant difference between the two surgical techniques (p = 0.18). In the clinical outcomes, the pain improvement was not significantly different between the two surgical techniques. In terms of surgical outcomes, OLIF resulted in a shorter length of hospital stay and less blood loss than TLIF (p < 0.0001 and p = 0.02, respectively). The present meta-analysis indicated no significant difference in clinical, radiological outcomes, and surgical time between TLIF and OLIF for DS, but the lengths of hospital stay and blood loss were better in OLIF than TLIF. Though encouraging, these findings were based on low-quality evidence from a small number of retrospective studies that are prone to bias.

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Section: Introductionmentioning

confidence: 99%

Transforaminal Lumbar Interbody Fusion (TLIF) versus Oblique Lumbar Interbody Fusion (OLIF) in Interbody Fusion Technique for Degenerative Spondylolisthesis: A Systematic Review and Meta-Analysis

Lee

Kim

Choo

et al. 2021

Life

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“… 56 Indeed, a new frontier of rapid recovery after lumbar fusion is to avoid general anesthesia altogether with the “awake TLIF,” which employs several key innovations including conscious sedation and long-acting local analgesia. 57 , 58 …”

Section: Resultsmentioning

confidence: 99%

Recoup From Home? Comparison of Relative Cost Savings for ACDF, Lumbar Discectomy, and Short Segment Fusion Performed in the Inpatient Versus Outpatient Setting

Mikhail

Echt

Selverian

et al. 2021

Global Spine Journal

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Study Design: Broad narrative review. Objective: To review and summarize the current literature on the cost efficacy of performing ACDF, lumbar discectomy and short segment fusions of the lumbar spine performed in the outpatient setting. Methods: A thorough review of peer- reviewed literature was performed on the relative cost-savings, as well as guidelines, outcomes, and indications for successfully implementing outpatient protocols for routine spine procedures. Results: Primary elective 1-2 level ACDF can be safely performed in most patient populations with a higher patient satisfaction rate and no significant difference in 90-day reoperations and readmission rates, and a savings of 4000 to 41 305 USD per case. Lumbar discectomy performed through minimally invasive techniques has decreased recovery times with similar patient outcomes to open procedures. Performing lumbar microdiscectomy in the outpatient setting is safe, cheaper by as much as 12 934 USD per case and has better or equivalent outcomes to their inpatient counterparts. Unlike ACDF and lumbar microdiscectomy, short segment fusions are rarely performed in ASCs. However, with the advent of minimally invasive techniques paired with improved pain control, same-day discharge after lumbar fusion has limited clinical data but appears to have potential cost-savings up to 65-70% by reducing admissions. Conclusion: Performing ACDF, lumbar discectomy and short segment fusions in the outpatient setting is a safe and effective way of reducing cost in select patient populations.

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“…Morgenstern and Morgenstern [ 22 ] report no major complications using percutaneous TLIF (pTLIF) with a posterolateral approach. Kolcun et al [ 23 ] found a 4% conversion rate without major intraoperative or postoperative complications in patients who underwent minimally invasive transforaminal fusion without general anesthesia. Ahn [ 3 ] notes that the working tube might cause irritation of the exiting nerve root especially in cases of prolonged surgery time.…”

Section: Discussionmentioning

confidence: 99%

Uniportal Endoscopic Lumbar Interbody Fusion

Wagner

Haefner

2020

Neurospine

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The cause of radiculopathy is the compression of the nerve root which can be secondary to sliding of the vertebra and reduced disc height. In some patients, decompression alone does not resolve this problem. We describe the uniportal endoscopic transforaminal lumbar interbody fusion technique. Full-endocopic foraminotomy and discectomy are followed by cage implementation and percutaneous instrumentation. The goal of this surgical method is decompression of nerve roots, segment stabilization, disc height, and sagittal alignment restoration. Uniportal endoscopic facet sparing transforaminal transkambin lumbar interbody fusion is a good surgical option to treat degenerative disc disease, mechanical instability, and spondylolisthesis. This method shows favourable clinical outcomes in selected patients.

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Endoscopic transforaminal lumbar interbody fusion without general anesthesia: technical innovations and outcomes

Cited by 31 publications

References 15 publications

Transforaminal Lumbar Interbody Fusion (TLIF) versus Oblique Lumbar Interbody Fusion (OLIF) in Interbody Fusion Technique for Degenerative Spondylolisthesis: A Systematic Review and Meta-Analysis

Transforaminal Lumbar Interbody Fusion (TLIF) versus Oblique Lumbar Interbody Fusion (OLIF) in Interbody Fusion Technique for Degenerative Spondylolisthesis: A Systematic Review and Meta-Analysis

Recoup From Home? Comparison of Relative Cost Savings for ACDF, Lumbar Discectomy, and Short Segment Fusion Performed in the Inpatient Versus Outpatient Setting

Uniportal Endoscopic Lumbar Interbody Fusion

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