“Pin Method” for Endoscopic Lumbar Interbody Fusion

Abstract

Background Endoscopic lumbar interbody fusion using a cage can have a similar fusion rate as minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) or open lumbar interbody fusion. Direct visual control during cage insertion is the key to prevent neural structure incarceration in endoscopic lumbar interbody fusion. Creating a track with any kind of retractor or cannula for cage insertion under fluoroscopic guidance is not safe enough, because the retractor and cannula can create many blind spots and can displace during cage insertion.

Method The pin method utilizes two flexible metallic guide pins inserted from the skin incision through the annulotomy site into the disk space until the anterior longitudinal ligament is reached under direct endoscopic monitoring. The two guide pins could be oriented parallel or perpendicular or even reduce to one or increase to many as needed to serve as a sliding track and a see-through barrier to prevent neural incarceration.

Results and Conclusion Two cases of L4/L5 grade 2 spondylolisthesis with neurogenic claudication were treated with endoscopic lumbar interbody fusion with 1-year follow-up, and the visual analog scale (VAS) score, Oswestry Disability Index (ODI) score, EuroQol five-dimensional questionnaire (EQ-5D, %) score, and modified Macnab score all improved greatly in both. The author developed an original, cheap, accessible, and safe method called the “pin method,” which can be used in both full-endoscopic and biportal surgery and can apply to various approaches and has no limitation on the size and shape of the cage.

Keywords

endoscopy - interbody fusion - lumbar - transforaminal - biportal

Publication History

Received: 09 July 2020

Accepted: 28 October 2020

Article published online:
27 May 2021

• References

• 1 Ahn Y, Youn MS, Heo DH. Endoscopic transforaminal lumbar interbody fusion: a comprehensive review. Expert Rev Med Devices 2019; 16 (05) 373-380
• 2 Park MK, Park SA, Son SK, Park WW, Choi SH. Clinical and radiological outcomes of unilateral biportal endoscopic lumbar interbody fusion (ULIF) compared with conventional posterior lumbar interbody fusion (PLIF): 1-year follow-up. Neurosurg Rev 2019; 42 (03) 753-761
• 3 Nagahama K, Ito M, Abe Y, Murota E, Hiratsuka S, Takahata M. Early clinical results of percutaneous endoscopic transforaminal lumbar interbody fusion: a new modified technique for treating degenerative lumbar spondylolisthesis. Spine Surg Relat Res 2018; 3 (04) 327-334
• 4 Li Y, Dai Y, Wang B. et al. Full-endoscopic posterior lumbar interbody fusion via an interlaminar approach versus minimally invasive transforaminal lumbar interbody fusion: a preliminary retrospective study. World Neurosurg 2020; (e-pub ahead of print)
• 5 Jacquot F, Gastambide D. Percutaneous endoscopic transforaminal lumbar interbody fusion: is it worth it?. Int Orthop 2013; 37 (08) 1507-1510
• 6 Osman SG. Endoscopic transforaminal decompression, interbody fusion, and percutaneous pedicle screw implantation of the lumbar spine: a case series report. Int J Spine Surg 2012; 6: 157-166
• 7 Morgenstern C, Yue JJ, Morgenstern R. Full percutaneous transforaminal lumbar interbody fusion using the facet-sparing, trans-Kambin approach. Clin Spine Surg 2020; 33 (01) 40-45
• 8 Youn MS, Shin JK, Goh TS, Lee JS. Full endoscopic lumbar interbody fusion (FELIF): technical note. Eur Spine J 2018; 27 (08) 1949-1955
• 9 Wu J, Liu H, Ao S. et al. Percutaneous endoscopic lumbar interbody fusion: technical note and preliminary clinical experience with 2-year follow-up. BioMed Res Int 2018; 2018: 5806037
• 10 Shen J. fully endoscopic lumbar laminectomy and transforaminal lumbar interbody fusion under local anesthesia with conscious sedation: a case series. World Neurosurg 2019; 127: e745-e750
• 11 Lee SH, Erken HY, Bae J. Percutaneous transforaminal endoscopic lumbar interbody fusion: clinical and radiological results of mean 46-month follow-up. BioMed Res Int 2017; 2017: 3731983
• 12 Jin M, Zhang J, Shao H, Liu J, Huang Y. Percutaneous transforaminal endoscopic lumbar interbody fusion for degenerative lumbar diseases: a consecutive case series with mean 2-year follow-up. Pain Physician 2020; 23 (02) 165-174
• 13 Lewandrowski KU, Ransom NA, Yeung A. Subsidence induced recurrent radiculopathy after staged two-level standalone endoscopic lumbar interbody fusion with a threaded cylindrical cage: a case report. J Spine Surg 2020; 6 (Suppl. 01) S286-S293
• 14 Morgenstern R, Morgenstern C. Percutaneous transforaminal lumbar interbody fusion (pTLIF) with a posterolateral approach for the treatment of denegerative disk disease: feasibility and preliminary results. Int J Spine Surg 2015; 9: 41
• 15 Yang J, Liu C, Hai Y. et al. Percutaneous endoscopic transforaminal lumbar interbody fusion for the treatment of lumbar spinal stenosis: preliminary report of seven cases with 12-month follow-up. BioMed Res Int 2019; 2019: 3091459
• 16 Heo DH, Son SK, Eum JH, Park CK. Fully endoscopic lumbar interbody fusion using a percutaneous unilateral biportal endoscopic technique: technical note and preliminary clinical results. Neurosurg Focus 2017; 43 (02) E8
• 17 Kim JE, Choi DJ. Biportal endoscopic transforaminal lumbar interbody fusion with arthroscopy. Clin Orthop Surg 2018; 10 (02) 248-252
• 18 Wang YT, Wu XT, Chen H, Wang C. Endoscopy-assisted posterior lumbar interbody fusion in a single segment. J Clin Neurosci 2014; 21 (02) 287-292
• 19 Kim JS, Jung B, Lee SH. Instrumented minimally invasive spinal-transforaminal lumbar interbody fusion (MIS-TLIF): minimum 5-year follow-up with clinical and radiologic outcomes. Clin Spine Surg 2018; 31 (06) E302-E309