Efficacy of PE-PLIF with a novel ULBD approach for lumbar degeneration diseases: a large-channel endoscopic retrospective study

Abstract

Purpose: This study aims to assess the effectiveness of Percutaneous Endoscopic Posterior Lumbar Interbody Fusion (PE-PLIF) combined with a novel Unilateral Laminotomy for Bilateral Decompression (ULBD) approach using a large-channel endoscope in treating Lumbar Degenerative Diseases (LDD).

Methods: This retrospective analysis evaluates 41 LDD patients treated with PE-PLIF and ULBD from January 2021 to June 2023. A novel ULBD approach, called 'Non-touch Over-Top' technique, was utilized in this study. We compared preoperative and postoperative metrics such as demographic data, Visual Analogue Scale (VAS) for pain, Oswestry Disability Index (ODI), Japanese Orthopedic Association (JOA) score, surgical details, and radiographic changes.

Results: The average follow-up duration was 14.41 ± 2.86 months. Notable improvements were observed postoperatively in VAS scores for back and leg pain (from 5.56 ± 0.20 and 6.95 ± 0.24 to 0.20 ± 0.06 and 0.12 ± 0.05), ODI (from 58.68 ± 0.80% to 8.10 ± 0.49%), and JOA scores (from 9.37 ± 0.37 to 25.07 ± 0.38). Radiographic measurements showed significant improvements in lumbar and segmental lordosis angles, disc height, and spinal canal area. A high fusion rate (97.56% at 6 months, 100% at 12 months) and a low cage subsidence rate (2.44%) were noted.

Conclusions: PE-PLIF combined with the novel ULBD technique via a large-channel endoscope offers significant short-term benefits for LDD management. The procedure effectively expands spinal canal volume, decompresses nerve structures, improves lumbar alignment, and stabilizes the spine. Notably, it improves patients' quality of life and minimizes complications, highlighting its potential as a promising LDD treatment option.

Keywords: Large-channel endoscope; Non-touch over-Top technique; PE-PLIF; ULBD.

Fig. 1

Endoscopic view of the ‘Non-touch Over-Top’ technique. a, b The interlaminar window was expanded using an endoscopic trepine, and the upper and lower endpoints of the LF were detached. c Initially performing ULBD using the endoscopic high-speed drill. d, e Decompression of contralateral LR. f DS and bilateral exiting nerve roots after ULBD. g Intervertebral space after discectomy. h Intervertebral bone grafting and cage implantation. The blue dashed line represents the median of the spinal canal, the blue triangle represents the cranial side, the blue square represents the cauda side. ULBD unilateral laminotomy for bilateral decompression, LR lateral recess, DS dural sac, LF ligamentum flavum, BSP base of spinous process, IL inferior lamina, SL superior lamina, NR nerve root, NP nucleus pulposus

Fig. 2

Six steps of the ‘Over-Top’ technique. A Ipsilateral laminectomy. B Decompression of the contralateral spinal canal while preserving the partial cortical bone near the LF. C Removal of the contralateral LF and the residual bone of lamina. D Decompression of contralateral LR. E Removal of the ipsilateral LF and discectomy. F Vertebral space bone grafting, cage and pedicle screws implantation. LF ligamentum flavum. LF ligamentum flavum, LR lateral recess

Fig. 3

Visualization of clinical data of functional outcomes. Visual analogue scale (VAS) scores for back pain a, VAS scores for leg pain b, Oswestry disability index (ODI) scores c, and Japanese Orthopaedic Association (JOA) scores d showed a significantly improvement trend postoperatively compared with preoperative values

Fig. 4

A 68-year-old male patient with severe intermittent claudication in both legs underwent PE-PLIF combined with the ‘Non-touch Over-Top’ technique. a preoperative AP X-ray fluoroscopy, and the green arrow showed I° spondylolisthesis at L_4-5 segment. b preoperative MRI, the green arrow showed central canal stenosis at the L_4-5 segment. c preoperative axial CT, and the green arrows showed bilateral LR stenosis at the L_4-5 segment. d 1d postoperative AP X-ray fluoroscopy showed solid fixation of the implant and the successful reduction of the L_4-5 segment. e 3d postoperative CT clearly demonstrated adequate spinal canal decompression. PE-PLIF percutaneous endoscopic posterior lumbar interbody fusion, AP anterior–posterior, ULBD unilateral laminotomy for bilateral decompression