Minimization of lumbar interbody fusion by percutaneous full-endoscopic lumbar interbody fusion (PELIF), and its minimally invasiveness comparison with minimally invasive surgery-transforaminal lumbar interbody fusion (MIS-TLIF)

Abstract

ObjectiveIn fusion surgery, minimization of muscle damage and bone resection is important. To achieve these, we have developed a percutaneous full endoscopic lumbar interbody fusion (PELIF). We report the detailed operation procedure, and moreover a comparison of its minimally invasiveness with that of the minimally invasive surgery-transforminal lumbar interbody fusion (MIS-TLIF). Methods52 patients were treated with PELIF. Total discectomy and cartilage endplate removal were performed using an 8 mm rotate-cutter. A cage was sandwiched between two L-retract sliders, which protected the exiting root. The cancellous bone chips were harvested from the pelvis with a 5 mm trephine.On the other hand, 74 patients were treated with MIS-TLIF. ResultsIn PELIF, bleeding volume, VAS (back pain), ODI, JOA score, and Macnab’s criteria were significantly superior to MIS-TLIF except for VAS (leg symptom).The MRI cross-sectional area of degenerative spondylolisthesis was significantly improved after PELIF, but that of MIS-TLIF was significantly broader.PELIF was superior to MIS-TLIF in fat degeneration of multifidus muscle in the cross-sectional MRI under 50 years old.CT recognized insufficient fusion in one case of PELIF and seven cases of MIS-TLIF, with a tendancy to have more insufficient fusion in MIS-TLIF. ConclusionsPELIF provides clear visualization under continuous water irrigation. PELIF is an indirect decompression without canal invasion. The dura mater, intestine, and large blood vessels don’t appear in the surgical field. It is understood that PELIF is a less invasive surgery than MIS-TLIF.