Awake Endoscopic Transforaminal Lumbar Interbody Fusion: A Technical Note.
Ontology highlight
ABSTRACT: Background
Advances in modern spinal fusion techniques have allowed for less peri-operative morbidity and more rapid recovery from surgery. The addition of endoscopy to minimally invasive surgery (MIS) fusion techniques represents the latest progression of efforts to minimize the impact of surgical intervention.Technique
MIS transforaminal lumbar interbody fusion (TLIF) is performed endoscopically through a sub-centimeter working portal. Patients undergo light conscious sedation and remain awake to facilitate feedback with the surgeon and enhance post-operative recovery.Results
Previously reported results of the first 100 cases performed by the senior author at a single institution are summarized. This cohort has been characterized by brief post-operative length of stay, low complication profile, and marked improvement in patient-reported outcomes scores, with no cases of pseudarthrosis at 1-year follow up.Conclusions
The latest technical considerations and adaptations of a novel technique for endoscopic MIS spinal fusion without general anesthesia are described. A refined surgical technique and anesthetic protocol are presented in detail with recommendations for the successful implementation and performance of the procedure.
SUBMITTER: Butler AJ
PROVIDER: S-EPMC7253549 | biostudies-literature |
REPOSITORIES: biostudies-literature
Similar Datasets
Project description:Biportal endoscopic transforaminal lumbar interbody fusion (TLIF) may have advantages of minimally invasive fusion surgery as well as those of endoscopic surgery. The purpose of this study was to present the biportal endoscopic TLIF technique along with video presentations and a review of the literature on this technique. Basically, the biportal endoscopic TLIF technique is similar to minimally invasive TLIF with a tubular retractor. There were 2 options in the biportal endoscopic TLIF procedures. The first was the insertion of one long TLIF cage and the other was the insertion of 2 short posterior lumbar interbody fusion (PLIF) cages. After the interbody fusion procedures, percutaneous pedicles screw fixation was performed. Biportal endoscopic TLIF achieved complete neural decompression through laminectomy and facetectomy like conventional TLIF. Endplate preparation was performed completely under a clear and magnified endoscopic view. It was also feasible to insert a large TLIF cage or 2 cages for PLIF without exiting nerve root injury. Biportal endoscopic TLIF might have the advantages of endoscopic surgery as well as minimally invasive fusion surgery. Direct neural decompression, endplate preparation under endoscopic guidance, and the insertion of a large TLIF cage or 2 PLIF cages may be the merits of biportal endoscopic lumbar fusion procedures.
| S-EPMC7410385 | biostudies-literature
Project description:PurposeThis study aimed to evaluate the clinical efficacy and imaging results of percutaneous endoscopic transforaminal lumbar interbody fusion (PETLIF) through comparing it with minimally invasive surgery-transforaminal lumbar interbody fusion (MISTLIF).Materials and methodsWe performed a retrospective analysis on patients with lumbar degenerative disease treated by PETLIF or MISTLIF from September 2017 to January 2019, and the patients were divided into two groups: the PETLIF group and the MISTLIF group. The clinical and imaging parameters of the two groups were evaluated.ResultsThere was no significant difference between the two groups in operative time and complication rate. The estimated blood loss and the length of hospital stay in the PETLIF group were significantly better than those in the MISTLIF group. Compared with those before operation, the postoperative VAS-L and VAS-B scores were significantly improved after operation in the both groups. In addition, the postoperative VAS-B score of the PETLIF group was significantly lower than that of the MISTLIF group. At the last follow-up, there was no significant difference between the two groups in the VAS-L score, VAS-B score, ODI score, and bony fusion rate.ConclusionsBoth PETLIF and MISTLIF could achieve satisfactory clinical outcomes in the treatment of lumbar degenerative disease, but our study suggested that PETLIF had less damage, rapid recovery after operation, and short discharge time.
| S-EPMC8626985 | biostudies-literature
Project description: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.
| S-EPMC6276503 | biostudies-literature
Project description:BackgroundThe previous studies agree that minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) has better function outcomes, less blood loss, and shorter hospital stay, when compared to open-TLIF. However, there are no significance differences on operative time, complication, and reoperation rate between the two procedures. This could be from less relative literatures and lower grade evidence. The further meta-analysis is needed with more and higher grade evidences to compare the above two TLIF procedures.MethodsProspective and retrospective studies that compared open-TLIF and MIS-TLIF were identified by searching the Medline, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang, and VIP database (the literature search comprised Medical Subject Heading terms and key words or Emtree term). The retrieval time ranged from the date when the database was founded to January 2015. Pooled risk ratios (RR s) and weighted mean differences (WMDs) with 95% confidence intervals were calculated for the clinical outcomes and perioperative data.ResultsTwenty-four studies (n = 1967 patients) were included in this review (n = 951, open-TLIF, n = 1016, MIS-TLIF). MIS-TLIF was associated with a significant decrease in the visual analog score (VAS)-back pain score (WMD = -0.44; P = 0.001), Oswestry Disabilities Index (WMD = -1.57; P = 0.005), early ambulation (WMD = -1.77; P = 0.0001), less blood loss (WMD = -265.59; P < 0.00001), and a shorter hospital stay (WMD = -1.89; P < 0.0001). However, there were no significant differences in the fusion rate (RR = 0.99; P = 0.34), VAS-leg pain (WMD = -0.10; P = 0.26), complication rate (RR = 0.84; P = 0.35), operation time (WMD = -5.23; P = 0.82), or reoperation rate (RR = 0.73; P = 0.32).ConclusionsMIS-TLIF resulted in a similar fusion rate with better functional outcome, less blood loss, shorter ambulation, and hospital stay; furthermore, it did not increase the complication or reoperation rate based on the existing evidence.
| S-EPMC4989430 | biostudies-literature
Project description:Background and Objectives: Lumbar disc degeneration (LDD) is the main cause of lower back pain and leads to corresponding disc height loss. Although lumbar interbody fusion (LIF) is commonly used for treating LDD, several different treatment strategies are available. We performed a minimally invasive full-endoscopic LIF (FELIF) using a uniportal full-endoscopic system. Materials and Methods: FELIF was performed for 12 patients with LDD with disc-height loss using a 4.1 mm working channel endoscope and a newly developed slider for cage insertion. The mean age of the patients was 68.3 years; the patients presented with single vertebral level involvement. The Brandner's disc index was used for evaluating the postoperative increase in the disc height. Preoperative and postoperative leg pain was evaluated using the numerical rating scale (NRS) score. Results: The mean operation time for FELIF was 109.4 min. The mean duration of hospital stay after FELIF was 7.7 days. There were no operative and postoperative complications, even without drainage during the mean follow-up period of 6.2 months (range, 2-10 months). The Brandner's disc index improved statistically significant (p > 0.01). The mean preoperative and postoperative NRS scores were 6.5 and 1.2, respectively. Conclusions: FELIF using a 4.1 mm working channel endoscope can be used for treating LDD with disc height loss. Radiculopathy caused by foraminal stenosis was the most suitable operative indication for FELIF.
| S-EPMC7559920 | biostudies-literature
Project description:BackgroundMinimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and oblique lateral interbody fusion (OLIF) are widely used in the treatment of lumbar degenerative diseases. In the present study, a meta-analysis was conducted to compare the clinical and radiographic efficacy of these two procedures.MethodsA systematic literature review was performed, and the quality of retrieved studies was evaluated with the Newcastle-Ottawa Scale (NOS). Clinical outcomes, including operation time, intraoperative blood loss, improvement in Visual Analogue Scale (VAS), improvement in Oswestry Disability Index (ODI), Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) effectiveness rate and complications, in addition to radiographic outcomes, including restoration of disc height, disc angle, overall lumbar lordosis, fusion rate and subsidence, were extracted and input into a fixed or random effect model to compare the efficacy of MIS-TLIF and OLIF.ResultsSeven qualified studies were included. Clinically, OLIF resulted in less intraoperative blood loss and shorter operation time than MIS-TLIF. Improvement of VAS for leg pain was more obvious in the OLIF group (P < 0.0001), whereas improvement of VAS for back pain (P = 0.08) and ODI (P = 0.98) as well as JOABPEQ effectiveness rate (P = 0.18) were similar in the two groups. Radiographically, OLIF was more effective in restoring disc height (P = 0.01) and equivalent in improving the disc angle (P = 0.18) and lumbar lordosis (P = 0.48) compared with MIS-TLIF. The fusion rate (P = 0.11) was similar in both groups, while the subsidence was more severe in the MIS-TLIF group (P < 0.00001).ConclusionsThe above evidence suggests that OLIF is associated with a shorter operation time (with supplementary fixation in the prone position) and less intraoperative blood loss than MIS-TLIF and can lead to better leg pain alleviation, disc height restoration and subsidence resistance. No differences regarding back pain relief, functional recovery, complications, disc angle restoration, lumbar lordosis restoration and fusion rate were found. However, due to the limited number of studies, our results should be confirmed with high-level studies to fully compare the therapeutic efficacy of MIS-TLIF and OLIF.Trial registrationPROSPERO ID: CRD42020201903 .
| S-EPMC8449429 | biostudies-literature
Project description:ObjectiveThe objective of this study is to compare the clinical efficacy of O-arm navigation and microscope-assisted minimally invasive transforaminal lumbar interbody fusion (modified MIS-TLIF) versus conventional TLIF in the lumbar isthmic spondylolisthesis.Materials and methodsForty patients with 1-level lumbar isthmic spondylolisthesis were enrolled in the study. Perioperative indexes including operation time, intraoperative bleeding, bed rest time, time of hospitalisation stay and the accuracy rate of screw placement were analysed. Preoperative and postoperative visual analogue scale (VAS) and Oswestry disability index (ODI) were assessed.ResultsThe operation time in the modified MIS-TLIF group was longer than the conventional TLIF group (p < 0.05). However, intraoperative blood loss in the modified MIS-TLIF group was less than the comparative group (p < 0.05). The average bed rest time and hospitalisation stay in the modified MIS-TLIF group was shorter than conventional TLIF group (p < 0.05). The screw placement in the modified MIS-TLIF group was more precisely than that in the conventional TLIF group (p < 0.05). Meanwhile, the improvement of VAS and ODI in the modified MIS-TLIF group were lower than that in the conventional TLIF group 1 and 6 months after operation (p < 0.05). There was no difference in the VAS and ODI score between the two group at the last follow-up (p > 0.05).ConclusionNavigation and microscope-assisted MIS-TLIF is safe and reliable for treatment of lumbar isthmic spondylolisthesis (Meyerding degree I or II) with potential advantages including less injury, less blood loss, higher screw accuracy and faster recovery after operation.The translational potential of this articleCompared with conventional transforaminal lumbar interbody fusion, O-arm navigation and microscope-assisted minimally invasive transforaminal lumbar interbody fusion has a huge advantage in surgery treatment of lumbar isthmic spondylolisthesis. Hence, this article provided a better surgery method to deal with lumbar isthmic spondylolisthesis, and robot-assisted minimally invasive transforaminal lumbar interbody fusion will be adopted in the future.
| S-EPMC6939115 | biostudies-literature
Project description:ObjectiveThere have been no clinical studies comparing different robotic techniques. We compare minimally invasive, robot-guided transforaminal lumbar interbody fusion (RGTLIF) and mini-open robot-guided posterior lumbar interbody fusion (RG-PLIF).MethodsUsing data from a prospective institutional registry, we identified 38 patients who underwent RG-PLIF. Propensity score matching using a nearest-neighbor algorithm was implemented to select RG-TLIF controls. Twelve-month patient-reported outcome measures are presented. A reduction of ≥ 30% from baseline was defined as the minimum clinically important difference (MCID).ResultsAmong the 76 included patients, there was no difference between RG-TLIF and RG-PLIF in surgical time (132.3 ± 29.4 minutes vs. 156.5 ± 53.0 minutes, p = 0.162), length of stay (55.9 ± 20.0 hours vs. 57.2 ± 18.8 hours, p = 0.683), and radiation dose area product (310.6 ± 126.1 mGy × cm2 vs. 287.9 ± 90.3 mGy × cm2, p = 0.370). However, while there was no difference among the 2 groups in terms of raw postoperative patient-reported outcome measures scores (all p > 0.05), MCID in leg pain was greater for RG-PLIF (55.3% vs. 78.9%, p = 0.028), and MCID in Oswestry Disability Index was greater for RG-TLIF (92.1% vs. 68.4%, p = 0.009). There was no difference concerning back pain (81.6% vs. 68.4%, p = 0.185).ConclusionOur findings suggest that both RG-TLIF and RG-PLIF are viable and equally effective techniques in robotic spine surgery.
| S-EPMC8021835 | biostudies-literature
Project description:IntroductionThe demand for spinal fusion surgery has increased over the last decades. Health care providers should take costs and cost-effectiveness of these surgeries into account. Open transforaminal lumbar interbody fusion (TLIF) and posterior lumbar interbody fusion (PLIF) are two widely used techniques for spinal fusion. Earlier research revealed that TLIF is associated with less blood loss, shorter surgical time and sometimes shorter length of hospital stay, while effectiveness of both techniques on back and/or leg pain are equal. Therefore, TLIF could result in lower costs and be more cost-effective than PLIF. This is the first systematic review comparing direct and indirect (partial) economic evaluations of TLIF with PLIF in adults with lumbar spondylolisthesis. Furthermore, methodological quality of included studies was assessed.MethodsSearches were conducted in eight databases for reporting on eligibility criteria; TLIF or PLIF, lumbar spondylolisthesis or lumbar instability, and cost. Costs were converted to United States Dollars with reference year 2020. Study quality was assessed using the bias assessment tool of the Cochrane Handbook for Systematic Reviews of Interventions, the Level of Evidence guidelines of the Oxford Centre for Evidence-based Medicine and the Consensus Health Economic Criteria (CHEC) list.ResultsOf a total of 693 studies, 16 studies were included. Comparison of TLIF and PLIF could only be made indirectly, since no study compared TLIF and PLIF directly. There was a large heterogeneity in health care and societal perspective costs due to different in-, and exclusion criteria, baseline characteristics and the use of costs or charges in calculations. Health care perspective costs, calculated with hospital costs, ranged from $15,867-$43,217 in TLIF-studies and $32,662 in one PLIF-study. Calculated with hospital charges, it ranged from $8,964-$51,469 in TLIF-studies and $21,838-$93,609 in two PLIF-studies. Societal perspective costs and cost-effectiveness, only mentioned in TLIF-studies, ranged from $5,702/QALY-$48,538/QALY and $50,092/QALY-$90,977/QALY, respectively. Overall quality of studies was low.ConclusionsThis systematic review shows that TLIF and PLIF are expensive techniques. Moreover, firm conclusions about the preferable technique, based on (partial) economic evaluations, cannot be drawn due to limited studies and heterogeneity. Randomized prospective trials and full economical evaluations with direct TLIF and PLIF comparison are needed to obtain high levels of evidence. Furthermore, development of guidelines to perform adequate economic evaluations, specified for the field of interest, will be useful to minimize heterogeneity and maximize transferability of results.Trial registrationProspero-database registration number: CRD42020196869.
| S-EPMC7877595 | biostudies-literature
Project description:OBJECTIVE:Lateral lumbar interbody fusion (LLIF) is a highly useful lumbar fusion surgical technique for degenerative spinal disease. However, many complications have already been reported. The purpose of this study is to report the concept, surgical technique, and clinical results of the first 70 consecutive cases treated with a safer and minimally invasive endoscopic-assisted LLIF (ELLIF). METHODS:This retrospective study included 70 cases involving 106 segments in which ELLIF was used to treat degenerative spinal disease. We examined the clinical progress, complications and analyzed radiographic images. Regarding the fusion rate, 49 cases involving 72 segments whose follow-up period was more than 7 months were evaluated. RESULTS:The mean of preoperative Numerical Rating Scale (NRS) was 7.0 and postoperative NRS was 1.4. Postoperative NRS had a significant correlation with the number of fusion segments (p = 0.028). The mean of preoperative disc space height, foraminal height, sagittal rotation angle, whole lumbar lordosis and sagittal translation distance were 3.3 mm, 14.3 mm, 2.4°, 9.7°, and 3.2 mm, respectively. Postoperative values were 9.4 mm, 17.9 mm, -4.9°, 36.3°, and 0.7 mm. The fusion rate was 79.2%. Complications included, transient psoas muscle weakness 1, sensory disturbance in the thigh 2, retroperitoneal injury 1, postoperative ileus possibly involving a retroperitoneal injury 1, and cage migration 4. CONCLUSION:Using the ELLIF in the degenerative spinal disease, we obtained good radiological reduction and good clinical results. Our study confirms that ELLIF is safer and provides better results for degenerative spinal disease. However, the issue of cage migration remains to be resolved.
| S-EPMC6449819 | biostudies-other