Unilateral approach with two-cage insertion for full endoscopic transforaminal lumbar interbody fusion: technical report

Lee, Dong Chan; Kim, Ji Yeon; Kim, Tae Hyun; Park, Choon Keun

doi:10.1007/s00701-022-05168-z

Cited by 4 publications

(4 citation statements)

References 5 publications

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“…Endoscopic spine surgeries, including full endoscopy and biportal endoscopy, have evolved from lumbar discectomy to the current treatment of a wide range of degenerative diseases [10][11][12][13][14]. Full endoscopic thoracic approaches have been used for https://doi.org/10.21182/jmisst.2023.01067 the treatment of thoracic stenosis and herniated discs.…”

Section: Discussionmentioning

confidence: 99%

Advanced Technique of 360° Decompression for Thoracic Spondylotic Myelopathy Using the Biportal Endoscopic Posterior Approach

Kim,

Choi

et al. 2024

J Minim Invasive Spine Surg Tech

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Section: Discussionmentioning

confidence: 99%

Advanced Technique of 360° Decompression for Thoracic Spondylotic Myelopathy Using the Biportal Endoscopic Posterior Approach

Kim,

Choi

et al. 2024

J Minim Invasive Spine Surg Tech

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“…Biportal endoscopic TLIF allows surgeons to use independent working portals for various cage insertions, including large oblique lateral interbody fusion and dual cages [3,4]. Furthermore, a novel cage guide device enables uniportal endoscopic TLIF to use large or multiple cages [5,6]. As a result of these technical developments, endoscopic TLIF surgeries have achieved good clinical outcomes and fusion rates comparable to those of conventional TLIF [3][4][5][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, a novel cage guide device enables uniportal endoscopic TLIF to use large or multiple cages [5,6]. As a result of these technical developments, endoscopic TLIF surgeries have achieved good clinical outcomes and fusion rates comparable to those of conventional TLIF [3][4][5][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Comparative Analysis of Uniportal and Biportal Endoscopic Transforaminal Lumbar Interbody Fusion in Early Learning Stage: Technical Considerations and Radiological Outcomes

Kim,

Hong,

Kim

et al. 2024

J Minim Invasive Spine Surg Tech

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Objective: This study compared the clinical and radiological outcomes of uniportal endoscopic and biportal endoscopic transforaminal lumbar interbody fusion (TLIF) for lumbar degenerative disease during the early learning stage of the technique.Methods: We retrospectively analyzed patients who underwent uniportal endoscopic TLIF (n=15) and biportal endoscopic TLIF (n=19) between January and October 2021 during the first year of adoption of these techniques. Radiological parameters, including Bridewell fusion and subsidence grading, were evaluated by x-ray and computed tomography (CT) at 3-month, 6-month, and 1-year follow-up visits. Clinical outcomes were evaluated using the visual analogue scale (VAS) and the Oswestry Disability Index (ODI).Results: Uniportal endoscopic TLIF showed significantly higher frequencies of intraoperative endplate injuries (uniportal [20%] vs. biportal [0%], p=0.01) and 1-year cage subsidence (uniportal [60%] vs. biportal [26.3%], p=0.04) than biportal endoscopic TLIF. The 1-year fusion rates did not differ significantly between the 2 surgical groups (uniportal [93.3%] vs. biportal [89.5%], p=0.37). Neural complications such as postoperative dysesthesia and dural tears occurred in uniportal endoscopic TLIF. There were no significant differences in the VAS for back and leg pain or ODI.Conclusion: Complete endplate preparation under endoscopic guidance improved interbody fusion, and this procedure may be feasible in the early learning stage, regardless of the type of endoscope. Both endoscopic TLIF techniques achieved good clinical outcomes and fusion rates. However, unskilled use of the cage guide device caused endplate breakage and neural injury during uniportal endoscopic cage insertion. Uniportal endoscopic TLIF may require more experience for appropriate cage insertion.

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“…2 Endoscopic spine surgery, including full endoscopy and biportal endoscopy, has evolved from lumbar discectomy to the current treatment of a wide range of degenerative diseases. [3][4][5][6][7][8] Spinal endoscopic techniques have also been developed to reduce the need for additional instruments. 4,9,10 Full endoscopic thoracic approaches have been used to treat thoracic stenosis and have shown good surgical outcomes.…”

Section: Introductionmentioning

confidence: 99%

Biportal Endoscopic Posterior Thoracic Laminectomy for Thoracic Spondylotic Myelopathy Caused by Ossification of the Ligamentum Flavum: Technical Developments and Outcomes

Kim

Ha²,

Lee

et al. 2023

Neurospine

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Objective: Advanced biportal endoscopic surgery techniques can be used to treat thoracic myelopathy secondary to ossification of the ligamentum flavum (OLF). This case series elaborates on a feasible biportal endoscopic technique for thoracic OLF removal and evaluates clinical and radiological outcomes.Methods: A biportal endoscopic posterior thoracic laminectomy was performed to remove the thoracic OLF. Surgical techniques have evolved from inside-out piecemeal removal methods to outside-in <i>en bloc</i> removal methods. Preoperative computed tomography was performed to analyze dural ossification and OLF types. Intraoperative videos were reviewed to observe dural ossification and to determine the surgical method. Neurological outcomes were assessed using the Japanese Orthopaedic Association (JOA) score.Results: Clinical symptoms and neurological function improved markedly after surgery (JOA score, preoperative: 12.6 ± 1.0, final follow-up: 15.6 ± 1.2). The mean operation time per segment was not short (106.6 ± 38 minutes). At early experience stages, inside-out piecemeal decompression was used and it caused intraoperative spinal cord injury. However, outside-in <i>en bloc</i> decompression technique did not induce neural complications. Postoperative segmental instability and correlated mechanical back pain were not observed.Conclusion: The biportal endoscopic posterior thoracic approach is an attractive surgical option to treat thoracic spondylotic myelopathy secondary to OLF. Piecemeal inside-out decompression can induce irreversible spinal cord injury, especially in the early experience stages. Outside-in decompression is more efficient and safer than inside-out pattern procedures by minimizing dural manipulation. Nonetheless, this technique is technically demanding and should only be performed in selected patients after acquiring abundant experience with endoscopic spine surgeries.

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Unilateral approach with two-cage insertion for full endoscopic transforaminal lumbar interbody fusion: technical report

Cited by 4 publications

References 5 publications

Advanced Technique of 360° Decompression for Thoracic Spondylotic Myelopathy Using the Biportal Endoscopic Posterior Approach

Advanced Technique of 360° Decompression for Thoracic Spondylotic Myelopathy Using the Biportal Endoscopic Posterior Approach

Comparative Analysis of Uniportal and Biportal Endoscopic Transforaminal Lumbar Interbody Fusion in Early Learning Stage: Technical Considerations and Radiological Outcomes

Biportal Endoscopic Posterior Thoracic Laminectomy for Thoracic Spondylotic Myelopathy Caused by Ossification of the Ligamentum Flavum: Technical Developments and Outcomes

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