Full Percutaneous Lumbar Interbody Fusion: Technical Note

Abstract

Introduction Although lumbar interbody fusion is effective for low back pain caused by severe disk degeneration, it is a highly invasive procedure. Less invasive procedures such as transforaminal lumbar interbody fusion (TLIF) and lumbar lateral interbody fusion have become available; however, there is still scope for improvement. We performed full percutaneous endoscopic lumbar interbody fusion (PELIF), a technique designed as a safe and less invasive percutaneous fusion. Method and Subjects Our technique is indicated for patients with chronic low back pain in whom conservative treatment was not effective, thinning of the intervertebral disk was prominent, and temporary pain relief was achieved with a disk block. In the operation, percutaneous endoscopic diskectomy was performed with a 7.5-mm sheath inserted through a small incision, and a cage was inserted percutaneously using an L-shaped retractor. Instead of pedicle screw fixation, hybrid facet screw fixation was performed. Low back pain was improved, and bone union was confirmed on radiography. This technique was used in six patients, and no surgery-related complications occurred. Discussion The L-shaped retractor used in this series can protect the exiting nerve by inserting it into the sheath, then removing the sheath and placing the rounded corner of the retractor on the lateral cranial side. This technique is safe with no other associated risks. Cages larger than the sheath can be inserted, and commercially available cages for TLIF are applicable. Hybrid facet screw fixation can overcome the problems associated with both conventional transfacet pedicle screw fixation and translaminar facet screw fixation by combining these two procedures. Conclusion PELIF is an easy, safe, and fully percutaneous technique with very low invasiveness that uses an L-shaped retractor and hybrid facet screw fixation. This procedure can be a treatment option for patients with severe low back pain related to disk degeneration.

Full-Endoscopic Lumbar Interbody Fusion for Treating Lumbar Disc Degeneration Involving Disc Height Loss: Technical Report

“…As the operation time of endoscope-assisted LIF, a standard approach in our hospital, was 102 (range, 59–162) min [ 24 ], 109.4 min was not significantly different from the operative time for the conventional approach. Likewise, the mean operation time was not inferior to that reported in previous FELIF studies (84.5–285.7 min) [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ]. Presently, we only perform FELIF for patients with LDD with disc height loss; the removal of the disc material is not a time-consuming step.…”

“…Previously, LIF was performed using open, microscopic, or endoscope-assisted surgical approaches. In contrast, uniportal full-endoscopic spine surgery (FESS) was originally introduced for the treatment of lumbar disc herniation and has recently been performed during posterior, lateral, and transforaminal LIF [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ]. Among these approaches, transforaminal LIF through Kambin’s triangle seems to be the most commonly used approach.…”