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J Neurol Surg A Cent Eur Neurosurg 2016; 77(04): 344-353
DOI: 10.1055/s-0035-1558821
Technical Note
Georg Thieme Verlag KG Stuttgart · New York

True Percutaneous Transforaminal Lumbar Interbody Fusion: Case Illustrations, Surgical Technique, and Limitations

Hasan Syed
1   Department of Neurological Surgery, Medstar Georgetown University Hospital, Washington, DC, United States
,
Jean-Marc Voyadzis
1   Department of Neurological Surgery, Medstar Georgetown University Hospital, Washington, DC, United States
› Author Affiliations
Further Information

Publication History

24 November 2014

15 May 2015

Publication Date:
20 August 2015 (online)

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Abstract

Objective The last decade has seen significant advances in minimally invasive techniques for lumbar interbody fusion that have reduced approach-related morbidity. Percutaneous lumbar interbody fusion involves a posterior transforaminal approach to the disk space with a minimal access port through the Kambin triangle. This technique obviates the need for the facetectomy or laminectomy required in a traditional transforaminal approach. This article describes the surgical technique, potential advantages and limitations, and representative case illustrations.

Methods Percutaneous transforaminal interbody fusion was performed on two patients with axial back and leg pain as a result of degenerative disk disease. Diskectomy and interbody cage insertion were completed through a tubular dilator placed onto the disk space in the Kambin triangle. Posterior fixation was achieved with percutaneous transfacet screws. Clinical outcome and postoperative complications are discussed.

Results Both patients demonstrated significant clinical improvement after surgery with > 1 year follow-up despite experiencing transient neurologic symptoms.

Conclusion Although this report demonstrates the feasibility and advantages of the approach, the technique is limited by the potential for nerve root injury and pseudoarthrosis.

Keywords

percutaneous - lumbar interbody fusion - minimally invasive - transfacet screw
 

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