General Session: Endoscopic Surgery
Presented by: R. Morgenstern - View Audio/Video Presentation (Members Only)
R. Morgenstern(1), C. Morgenstern(2)
(1) Centro Médico Teknon, Barcelona, Spain
(2) Charité - Universitaetsmedizin Berlin, CMSC, Berlin, Germany
Introduction: Interbody fusion by open discectomy is the usual treatment for degenerative disk disease but requires a relatively long recovery period. The transforaminal posterolateral approach is a well-known standard in endoscopic spine surgery that allows direct access to the disk with progressive tissue dilation, avoiding tissue and bone dissection. The aim of this study was to assess the feasibility of percutaneous transforaminal interbody fusion (pTLIF) for lumbar spinal fusion. pTLIF consists of percutaneous insertion of an expandable or a standard rigid interbody implant with the endoscopic posterolateral approach and percutaneous posterior fixation with transpedicular screws and rods for patients with degenerative disk disease with or without spondylolisthesis. This technique is also useful for revision surgery as it allows bypassing posterior scar tissue from previous operations.
Methods: Between 2009 and 2016, the pTLIF procedure was performed in 50 patients in our facility. Ten patients underwent insertion of a rigid implant (group A) and 40 patients underwent insertion of an expandable titanium interbody implant as the initial procedure (n = 25) (group B) or after failed back surgery (n = 15) (group C). Patient outcomes were scored with visual analogic scale (VAS), Oswestry disability index (ODI) and modified Macnab criteria.
Results: The mean follow-up period was 42 (16) (range 6 to 79) months. The outcome was excellent in 25, good in 22 and fair in 3 according to Macnab criteria. No poor results and no major complications like subsidence and pseudo-arthrosis have been reported. In 6 cases transient ipsilateral dysesthesia was reported post-operatively that resolved in a median time of 5 weeks with oral corticoid treatment. Median postoperative time until hospital discharge was 27 hours (18 to 76 hours). Post-operative values for VAS and ODI scores (post-operative median scores at 12 months follow-up: VAS back 2,8, VAS leg 0,6, ODI 12,8) improved significantly (p < 0.05) compared to preoperative data in all study groups (pre-operative median scores: VAS leg 7,1, VAS back 6,6, ODI 32,3). No significant (p < 0.05) differences in VAS and ODI scores according to the study group were found.
Conclusions: Our results show the feasibility of the pTLIF procedure using the endoscopic posterolateral approach for the treatment of degenerative disk disease with or without spondylolisthesis up to grade 2 and in revision surgery. Median postoperative time until hospital discharge was faster compared to standard open TLIF (27 hours vs. 9.3 days). This new technique has disruptive potential in lumbar spinal fusion surgery and opens the way to ambulatory fusion surgery in outpatient clinics.