Percutaneous Transforaminal Endoscopic Lumbar Interbody Fusion: Clinical and Radiological Results of Mean 46-Month Follow-Up

Abstract

Background. Spinal fusion has been shown to be the preferred surgical option to reduce pain, recover function, and increase quality of life in the treatment of a variety of lumbar spinal disorders. The main goal of the present study is to report our clinical experience and results of percutaneous transforaminal endoscopic lumbar interbody fusion (PELIF) applications using the expandable spacer in a single institution. Methods. We performed a retrospective review of 18 patients with >12-month follow-up who had been operated on PELIF using expandable spacer from 2001 to 2007. Their clinical and radiological data were collected and analyzed. Results. The mean follow-up period was 46 months. The mean DH before the surgery was 8.3 mm which improved to 11.4 mm at the early postoperative period and regressed to 9.3 mm at the last follow-up visit. The VAS-B, VAS-L, and ODI scores at the last follow-up showed a 54%, 72%, and 69% improvement from the preoperative period, respectively. Conclusions. The presented PELIF technique with the expandable spacer seems to be a promising surgical technique for the treatment of a variety of lumbar spinal disorders. Conversely, radiological results including disc space subsidence make the stand-alone application of the expandable spacer debatable.

Figure 1

Representative case involving a patient with DDD and instability at the L4-5 level. (a-b) Fluoroscopic images showing disc removal using endoscopic forceps and endplate preparation using an endoscopic curette. (c) A trial implant without expansion in disc space is shown. (d-e) Fluoroscopic images showing the final construct with an expandable B-Twin spacer.

Figure 2

A 37-year-old male patient (patient number: 15 in the tables) with DDD and HNP at the L4-5 level. Lateral standing X-rays showing (a) preoperative, (b) early postoperative, and (c, d, e) final follow-up X-rays including standing lateral neutral, extension, and flexion views taken at 50 months after the surgery. Note that there is 1.9 mm reduction of the DH at the final follow-up examination compared to the early postoperative period. The operated level remained stable in extension and flexion views. The patient's VAS-B, VAS-L, and ODI scores were 1.4, 2, 4.4, respectively, at the final follow-up visit. The patient rated his result as “excellent.”

Figure 3

A 50-year-old female patient (patient number: 3 in the tables) with DDD at the L4-5 level. Lateral standing X-rays showing (a) preoperative, (b) early postoperative, and (c) final follow-up X-rays including standing lateral neutral views taken at 32 months after the surgery. It can be seen that the limbs of the implant are broken and there is a 2.5 mm reduction in DH at the final follow-up examination compared to the early postoperative period. The patient's VAS-B, VAS-L, and ODI scores were 4, 2.5, 31.1, respectively, at the final follow-up visit. The patient rated her result as “fair.”