Abstract
Objective: In minimally invasive techniques for transforaminal lumbar interbody fusion (MIS TLIF) access to the disc and by consequence, the extension of the discectomy can be reduced. Insufficient disc removal and endplate violation can lead to non-unions, subsidence and pseudoarthroses. In this study, we compare the quality of disc preparation, volume of bone graft and clinical results in a group of patients who underwent MIS TLIF with discectomy and endplate preparation aided by an automated discectomy device, the enSpireTM Flex MIS Surgical Discectomy System (study group) to a control group with classical, manual instrumentation for disc preparation. Materials and methods: Twenty-seven consecutive patients were enrolled in the study group and 33 patients in the control group. All patients received similar mixture of autologous bone and cadaver allograft. Disc volume and the quantity of graft placed in the disc space was measured on the discharge CT scan and compared in a blinded, independent radiology review. Clinical outcomes assessed using the Visual Analog Scale (VAS) for leg and low back pain and the Oswestry Disability Index (ODI) were compared at 12 months postoperative. Results: The mean volume of bone graft placed and the ratio bone graft/nucleus was higher in the study group (6.21 cm3 vs. 4.39 cm3 ; p<0001 and 76.8% vs. 57.8%; p<0.0001). The mean Patient Satisfaction Index (PSI) of the EnSpire group was statistically higher than the control group (4.6 ± 0.6 vs. 3.9 ± 0.7). Conclusion: In the challenging MIS TLIF approach, we demonstrate that by using the enSpire™ Flex MIS Surgical Discectomy System, we can optimize the extension and quality of the discectomy, increase the volume of bone graft, and achieve better clinical outcomes.
Highlights
IntroductionTransforaminal Lumbar Interbody Fusion (TLIF) demonstrates advantages over the anterior and bilateral posterior procedures because it requires only unilateral access to the disc via a far-lateral approach; thereby minimizing the risk of vascular and neurologic complications [1,2,3,4,5,6,7,8,9]
A variety of techniques exist for interbody fusion of the lumbar spine
In the challenging MIS Transforaminal Lumbar Interbody Fusion (TLIF) approach, we demonstrate that by using the enSpireTM Flex MIS Surgical Discectomy System, we can optimize the extension and quality of the discectomy, increase the volume of bone graft, and achieve better clinical outcomes
Summary
Transforaminal Lumbar Interbody Fusion (TLIF) demonstrates advantages over the anterior and bilateral posterior procedures because it requires only unilateral access to the disc via a far-lateral approach; thereby minimizing the risk of vascular and neurologic complications [1,2,3,4,5,6,7,8,9]. During MIS TLIF, access to the disc and by consequence, the extension of the discectomy, can be reduced [12]. Tools designed to provide improved access to the disc space will enable more complete removal of nucleus and, increased cross sectional area of bone graft, and reduced problems in cage placement, in-growth of fibrous tissue, and incidence of pseudoarthroses [18]. The automated enSpireTM Flex Surgical Discectomy System has been designed with those specific aims
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