Percutaneous Endoscopic Transforaminal Lumbar Interbody Fusion for the Treatment of Lumbar Spinal Stenosis: Preliminary Report of Seven Cases with 12-Month Follow-Up.

Jincai Yang,Chang Liu,Peng Yin,Yi Ding,Liming Zhang,Yaoshen Zhang,Lijin Zhou,Yangpu Zhang,Yong Hai,Chunyang Xu,Aixing Pan

doi:10.1155/2019/3091459

Abstract

Purpose The objective of this study was to investigate the preliminary effectiveness of percutaneous endoscopic transforaminal lumbar interbody fusion (PE-TLIF) for the treatment of lumbar spinal stenosis (LSS). Methods From September 2016 to June 2017, a series of seven patients consisting of six females and one male with an average age of 55.25 years (range 43–77 years) who were diagnosed with LSS were involved in this study. All patients were treated by PE-TLIF. During perioperative and follow-up period, demographic data, operation time, intraoperative blood loss, Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), and modified MacNab criteria were evaluated and perioperative complications were documented. Results All patients were followed up for more than 12 months, with an average follow-up time of 15 (range 12-21) months. The mean VAS of back pain was 7.43 (range 6-8) preoperatively and 0.86 (range 0-2) at the final follow-up. The mean VAS of leg pain was 6.14 (range 4-9) preoperatively and 0.71 (range 0-1) at the final follow-up. The mean ODI was 53.57% (range 38%-63%) preoperatively and 15.57% (range 5%-26%) at the final follow-up. In three-month follow-up, continuous bone trabeculae bridging between intervertebral bodies was seen in 3 cases, and the remaining 4 cases could identify continuous bone trabeculae bridging at 6-month follow-up, reaching the standard of spinal intervertebral fusion. At the final follow-up, 4 patients were rated as excellent (4/7) and 3 patients were rated as good (3/7) according to the modified MacNab criteria. Conclusions Our study suggested that percutaneous endoscopic transforaminal lumbar interbody fusion could acquire satisfactory treatment effects for the patients with lumbar spinal stenosis, even for the patient who could not afford general anesthesia.

Highlights

Low back pain is the major worldwide pathology of disability which gives rise to an increasing social burden among the expanding and ageing population [1]
In three-month follow-up, continuous bone trabeculae bridging between intervertebral bodies was seen in 3 cases, and the remaining 4 cases could identify continuous bone trabeculae bridging at 6-month follow-up, reaching the standard of spinal intervertebral fusion
At the final follow-up, 4 patients were rated as excellent clinical outcomes (4/7) and 3 patients were as good clinical outcomes (3/7) according to the modified MacNab criteria

Summary

Introduction

Low back pain is the major worldwide pathology of disability which gives rise to an increasing social burden among the expanding and ageing population [1]. It is reported that 50% of elder patients suffer from lumbar degenerative diseases accompanied by low back pain [2]. Traditional operations can acquire good curative effect, whereas high complication rates were reported owing to severe paraspinal iatrogenic damage and potential risks of nerve root injury [6]. In 2002, Khoo and Foley firstly reported MISTLIF (minimally invasive TLIF) [7] and advantages of MISTLIF included the following aspects: reduced paraspinous muscle injury, minimized perioperative blood loss, quicker recovery time, and reduced risk of infection at surgical sites [8, 9]. A minimally invasive procedure with well-designed paraspinous muscle preservation and nerve protection may be necessary

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Conclusion