General Session: Endoscopic Surgery
Presented by: J. Yue
J. Yue(1), Y. Guo(2), Y. Tian(2)
(1) Yale University School of Medicine, Guilford, CT, United States
(2) Yale University School of Medicine, New Haven, CT, United States
Background: Interbody spine fusion with cages was first described by Bagby and has been performed for a long time now in a variety of different conditions. Here we used a posterolateral approach to perform full endoscopic lumbar fusion using minimally invasive expandable cage, indirect reduction and unilateral pedicle screw fixation.
Materials and Methods: From 2014 to 2015, full endoscopic postero-lateral lumbar targeted decompression and fusion was performed on 27 patients with a mean age of 56.1 years old (range 29 to 83 years). 15 patients were female and 12 patients were male. The main BMI was 29.3 (range 23.5 to 40.2). All the patients underwent full endoscopic lumbar targeted decompression of stenotic disc and or facet inducing stenosis lesions using a Kambin triangle posterolateral approach under general anesthesia. Following decompression, an endoscopic expandable cage (Rise, Globus, Audobon, PA USA) was deployed for indirect decompression. Unilateral posterior pedicle screw fixation and autologous iliac crest bone graft was then placed. Facet complexes were not resected. Spinal cord monitoring was utilized in all cases. Both clinical and radiographic outcome analysis was performed. Complications were noted.
Results: Minimum follow-up was 22 months. The mean operating time for all 27 patients was 2.23 hours with a mean estimated blood loss (EBL) of 103.6mL. The mean hospital stay was 1.7 days (range 1 to 3 days). 6 cases were L3/4 level. 18 cases were L4/5 level and 3 cases was L5/S1 level. Post-operatively, the mean anterior disc height increased from 9.64mm to 13.21mm (P=0.018), and mean posterior disc height increased from 6.95mm to 10.45mm (P=0.007). All patients acquired significant improvement in both axial lumbar pain and leg pain after short term follow up. The VAS score for axial lumbar pain improved 6.86 to 1.57 (P< 0.001) and VAS score for leg pain improved from 5.43 to 1.57 (P=0.005) after surgery. There is no migration of the cages. One patient had dorsiflexion weakness of 4/5 for 3 weeks after surgery. 22.9% had complaints of L4 radicular complaints which resolved on average of 8.3 weeks post operatively.
Conclusions: The technique was introduced in our practice to care for patients with degenerative lumbar foraminal stenosis secondary to disc and or facet impingement. Our results indicate excellent clinical outcomes and fusion rates of 95%. Minimal blood loss and no long term complications were experienced. All procedures were performed under general anesthesia with spinal cord monitoring. Based on our experience, the technique of minimally invasive facet sparing full endoscopic lumbar targeted decompression and interbody fusion using expandable cages is a reliable and safe technique for the treatment of symptomatic lumbar foraminal stenosis.