Abstract
Objective Endoscopic surgeries have been attempted in the field of lumbar decompression and fusion surgery in the past decade. Percutaneous endoscopic lumbar interbody fusion (PELIF) is a new-emerging technique taking advantages of an anatomical (Kambin's triangle) to achieve simultaneous decompression and fusion under endoscopic visualization. The purpose of this study is to evaluate the feasibility and safety of PELIF technique with general anesthesia and neuromonitoring. Methods The authors present the details of PELIF technique with general anesthesia and neuromonitoring. The first 7 consecutive patients treated with minimum of 2 year's follow-up were included. Clinical outcomes were assessed by visual analog scale (VAS) for back and leg pain, Oswestry Disability Index (ODI) scores, and the Short Form-36 health survey questionnaire (SF-36) in the immediate preoperative period and during the follow-up period. Results All patients underwent single-level PELIF surgery successfully and without conversion to open surgery. The average age was 56.0±13.0 years. All patients had Grade I degenerative/isthmic spondylolisthesis and 4 patients coexisted with disc herniation. The mean operative time was 167.5±30.9 minutes, and intraoperative blood loss was 70.0±24.5 ml. Postoperative drainage volume was 24.5±18.3 ml. The differences in the VAS scores for low back pain and leg pain between preoperative and follow-up were significant (P<0.05). The SF-36 Physical Component Summary (PCS) improved from 38.83±4.17 to 55.67±2.58 (P<0.001). The SF-36 Mental Component Summary (MCS) improved from 43.83±3.13 to 57.50±5.36 (P=0.001). The ODI score improvement rate was 33.7±3.7 %. All cases demonstrated radiopaque graft in the intervertebral disc space consistent with solid arthrodesis. Conclusions PELIF technique seems to be a promising surgical technique for selected appropriate patients, with the minimal invasive advantages in decreased blood, shortage of ambulation time, and hospital stay, compared with MIS-TLIF. Because of limited Kambin's triangle space and the exiting nerve root nearby, PELIF is still a challenging technique. Future advancement and development in instrument and cage design are vital for application and popularization of this technique. Prospective, randomized, controlled studies with large sample size on PELIF technique are still needed to prove its safety, efficacy, and minimal invasive advantages.
Highlights
Conventional open posterior fusion surgery of the lumbar spine, though addressing the pathology adequately, may—depending on significant surgical destruction of posterior muscular-ligamentous complex—lead to muscular atrophy, postoperative back pain, and functional disability [1,2,3,4]
Several factors which include, but are not limited to, the desire to minimize complications and hospitalization; the desire to facilitate an early return to productive hospitalization; the desire for elderly patients to return to active premorbid status; and the desire to decrease the cost of medical care have combined to facilitate the paradigm shift from open to minimally invasive spine surgery (MIS) [5, 6]
We will mainly focus on percutaneous endoscopic lumbar interbody fusion technique (PELIF) based on full-endoscopic technique through Kambin’s triangle, with a similar surgical access and manipulation as percutaneous endoscopic discectomy (PELD)
Summary
Conventional open posterior fusion surgery of the lumbar spine, though addressing the pathology adequately, may—depending on significant surgical destruction of posterior muscular-ligamentous complex—lead to muscular atrophy, postoperative back pain, and functional disability [1,2,3,4]. There are many types of MIS lumbar fusion surgery, including transforaminal lumbar interbody fusion (TLIF), anterior lumbar interbody fusion (ALIF), extreme lateral lumbar interbody fusion (XLIF), and posterior lumbar interbody fusion (PLIF) [2, 7]. All these procedures, though sharing the label of MIS, have different attributes in terms of BioMed Research International distraction of the normal anatomic structures; accessibility to the different levels of the spine [8]. The purpose of this article was to demonstrate the surgical technique of PELIF and share preliminary clinical experience
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