Uniportal Endoscopic Lumbar Interbody Fusion

Abstract

The cause of radiculopathy is the compression of the nerve root which can be secondary to sliding of the vertebra and reduced disc height. In some patients, decompression alone does not resolve this problem. We describe the uniportal endoscopic transforaminal lumbar interbody fusion technique. Full-endocopic foraminotomy and discectomy are followed by cage implementation and percutaneous instrumentation. The goal of this surgical method is decompression of nerve roots, segment stabilization, disc height, and sagittal alignment restoration. Uniportal endoscopic facet sparing transforaminal transkambin lumbar interbody fusion is a good surgical option to treat degenerative disc disease, mechanical instability, and spondylolisthesis. This method shows favourable clinical outcomes in selected patients.

Keywords: Decompression; Endoscopic interbody fusion; Lumbar interbody fusion; Spinal stenosis; Surgical technique; Transforaminal endoscopy.

Fig. 1.

(A) Surgery set-up. (B) Prone position with positioning cushion.

Fig. 2.

(A) Approach planning. (B) Approach lateral view. (C) Skin marking.

Fig. 3.

Position of the needle at a 45° angle.

Fig. 4.

(A) Placement of the needle parallel to the upper and lower endplate at the center of the disc. (B) Intraoperative placement of Kirschner wire.

Fig. 5.

(A) Dilators, drills, and Jamshidi needle. (B) Use of the drill.

Fig. 6.

(A) Reinsertion of guidewire. (B) Endoscopic view guidewire.

Fig. 7.

(A) Titanium cage insertion over-the-wire. (B) Cage insertion. (C) Cage insertion. (D) Final control x-ray (anteroposterior) cage placement. (E) Final control x-ray (lateral) cage placement.

Fig. 8.

(A) Final control x-ray (anteroposterior). (B) Final control x-ray (lateral).

Fig. 9.

Size of skin incisions at the end of surgery.