Oblique Lateral Endoscopic Decompression and Interbody Fusion for Severe Lumbar Spinal Stenosis: Technical Note and Preliminary Results

Abstract

Objective: Adequacy of decompression for oblique lateral interbody fusion (OLIF) is a real concern in patients with severe lumbar spinal stenosis (LSS). With this in mind, we combined OLIF with spinal endoscopic technique to achieve a solid fusion and an adequate decompression after one operation.Methods: This is a technical note. The theoretical basis and operation process of this technique were introduced, and consecutive cases were retrospectively collected. Consecutive patients diagnosed with monosegmental severe LSS (L4/5) and underwent oblique lateral endoscopic decompression and interbody fusion (OLEDIF) from January 2018 to February 2020 were retrospectively collected. Clinical outcomes were assessed by claudication distance, Visual Analog Scale (VAS), and Oswestry Disability Index (ODI) scores. Secondary indicators included operation time, operative blood loss, and postoperative complications.Results: Ten patients were selected for the OLEDIF procedure. They were five women and five men ranging in age from 49 to 75 years (mean age of 63.9 years) and in BMI from 25.4 to 30.2 kg/m 2 (mean BMI of 27.5 kg/m 2 ). The preoperative claudication distance was 160.00 AE 68.96 m (range 70-250 m), which was significantly extended on the 3-month and 1-year follow-up (1020.00 AE 407.70 m and 1040.00 AE 416.87 m, respectively). The preoperative VAS score of back pain and radiating leg pain was 5.50 AE 0.97 (range 4-7) and 6.40 AE 0.97 (range 5-8). The score on postoperative month 3 was 1.60 AE 0.52 (range 1-2) and 1.20 AE 0.79 (range 0-2), and the 1-year follow-up score was 1.90 AE 0.74 (range 1-3) and 1.60 AE 0.70 (range 1-3), respectively. The preoperative ODI was 72.23 AE 6.30 (range 64.4-82.2), the 3-month follow-up ODI was 31.12 AE 4.20 (range 24.4-35.6), and the 1-year follow-up ODI was 29.33 AE 5.92 (range 20.0-37.8). Compared with the transforaminal lumbar interbody fusion (TLIF) in the literature, the operation time was not prolonged (189.3 AE 32.5 min vs. 214.9 AE 60.0 min) but the amount of blood loss decreased significantly (113.3 AE 26.7 ml vs. 366.8 AE 298.2 ml). No complications were found except one case presented with dysesthesia of the left leg. Imaging results showed good fusion without cage subsidence during 1-year follow-up. Conclusion:OLEDIF can achieve complete ventral decompression of the spinal canal and solid fusion of the lumbar spine at one time. It is an effective minimally invasive technique for the treatment of monosegmental severe LSS, which is promising and worthy of further clinical practice.

Comparison of the Medium‐term Outcomes of Anterior Lumbar Discectomy and Fusion with Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Retrospective Cohort Study

“…More sufficient and direct decompression or supplementary posterior decompressive procedure after indirect decompression may be necessary 19,20 . Additionally, spine surgeons try to use microscope‐assisted ALIF and spinal endoscope‐assisted OLIF to complete ventral neural decompression 6,8–11,18,20,21 . However, the anatomical complexity of the anterior approach and the limited surgical space due to the loss of intervertebral height may make the clinical application of these two techniques more challenging.…”

“…However, its applicability is predominantly restricted to cases involving large herniated or prolapsed discs situated in the right lateral recess or central canal. 11 Meanwhile, endoscopic lumbar interbody fusion remains challenging for patients with bilateral foraminal stenosis, severe central stenosis, or high-grade spondylolisthesis. 12 For different types of LDDs, the indications and contraindications should be comprehensively considered to select the appropriate lumbar fusion surgery.…”

“…However, it is unsuitable for coexisting central canal or lateral recess stenosis, as well as completely collapsed disc space 8 . Various studies have demonstrated that spinal endoscope‐assisted OLIF results in successful direct neural decompression in degenerated lumbar diseases with huge lumbar disc herniation or cauda equina syndrome 6,9–11 . The constraints associated with spinal endoscopic discectomy‐assisted OLIF, particularly concerning pathologies in the left foramen, have been elaborated 6 .…”

“…The advanced oblique lateral endoscopic decompression and interbody fusion (OLEDIF) technique facilitates precise visualization of the posterior annulus fibrosus, nucleus pulposus, and osteophytes, achieved through a 30°–60° lens end view. However, its applicability is predominantly restricted to cases involving large herniated or prolapsed discs situated in the right lateral recess or central canal 11 . Meanwhile, endoscopic lumbar interbody fusion remains challenging for patients with bilateral foraminal stenosis, severe central stenosis, or high‐grade spondylolisthesis 12 …”

“… 8 Various studies have demonstrated that spinal endoscope‐assisted OLIF results in successful direct neural decompression in degenerated lumbar diseases with huge lumbar disc herniation or cauda equina syndrome. 6 , 9 , 10 , 11 The constraints associated with spinal endoscopic discectomy‐assisted OLIF, particularly concerning pathologies in the left foramen, have been elaborated. 6 The advanced oblique lateral endoscopic decompression and interbody fusion (OLEDIF) technique facilitates precise visualization of the posterior annulus fibrosus, nucleus pulposus, and osteophytes, achieved through a 30°–60° lens end view.…”