Article Figures & Data
Figures
- Figure 1
Case 1: a 32-year-old male with discogenic low back pain and spondylolysis. (A) Preoperative computed tomography sagittal reconstruction showed L5 spondylolysis. (B) Preoperative sagittal T2-weighted magnetic resonance imaging showed a degenerative, bulging L5-S1 disc. (C) Percutaneous puncture to the intervertebral foramen under fluoroscopy guidance. The needle tip was located at the posterior upper edge of the lower vertebral body in the lateral view. The direction was parallel to the intervertebral space, located on the central line of the pedicle under the anteroposterior fluoroscopy. A guidewire was introduced along the puncture needle. (D, E) A beveled working sleeve was placed along the soft tissue dilator, and the position of the protective sleeve was confirmed again. (F) A 10-mm-diameter trephine was used in the protective sleeve to remove the lateral and ventral bone from the superior articular process and use it for interbody bone grafting. (G) The schematic diagram showed the working zone of the protective sleeve and trephine. The beveled tip of the protective sleeve protected the exiting nerve root, and the traversing nerve root protected by the ligamentum flavum.
- Figure 2
Case 2: a 56-year-old male with L5-S1 Modic changes and lateral recess and foraminal stenosis. (A, B) Preoperative lumbar magnetic resonance imaging showed Modic changes in the upper and lower endplates of the L5-S1 disc and left foraminal stenosis. (C) The preoperative axial computed tomography (CT) scan showed calcified herniated disc compression on the left S1 nerve root. (D) Full-endoscopic exposure of calcified herniated disc. (E) The full-endoscopic view showed the positional relationship between the decompressed nerve root and the fusion cage. (F) Postoperative sagittal CT reconstruction showed left foraminal decompression. (G) Postoperative axial CT showed sufficient decompression of left lateral recess and foramen. (H) Postoperative sagittal CT reconstruction showed L5-S1 interbody fusion. Orientation of the field of view under full endoscope: left, cephalad side; right, caudal side; upper, medial side; lower, lateral side (left side). HD indicates herniated disc; and NRT, nerve root.
- Figure 3
Case 3: a 62-year-old male with isthmic spondylolisthesis. (A) Lateral radiography showed isthmic spondylolisthesis at the L5 level. (B) Preoperative axial T2-weighted magnetic resonance imaging (MRI) showed bilateral foraminal stenosis. (C) Full-endoscopic view of decompressed left L5 nerve root. (D) Three-month postoperative axial T2-weighted MRI showed bilateral foraminal decompression. (E) One-year postoperative sagittal computed tomography reconstruction showed an anatomical reduction of spondylolisthesis and solid interbody fusion. Orientation of the field of view under full endoscope: left, cephalad side; right, caudal side; upper, dorsomedial side; lower, ventrolateral side (left side). NRT indicates nerve root.
- Figure 4
Case 1, continued: surgical technique steps. (A) Rotate the working sheath under full-endoscopic surveillance and protect the exiting nerve root with the tongue end of the working sheath. (B) Use a curette to scrape the cartilage endplate of the upper and lower vertebral bodies under a full endoscope. (C) Prepare the bony endplates to expose the subchondral bone. (D) Place the allograft and rh-BMP-2 into the anterior half of the intervertebral space under press-fit. (E) Insert a guidewire into the intervertebral space the beveled endoscopic working sheath to protect the exiting nerve root by rotating it out of the way. Place a trial for sizing. Insert the bullet-shaped interbody fusion cage filled with autogenous bone and rhBMP-2 over the guidewire. (F) Explore the finished interbody fusion to directly visualize the exiting nerve root and define its relationship with the fusion cage. Orientation of the field of view under full endoscope: left, cephalad side; right, caudal side; upper, medial side; lower, lateral side (left side). FL indicates flavum ligament; AF, annulus fibrosis; EP, endplate; and NRT, nerve root.
- Figure 5
Case 1, continued. (A, B) Anteroposterior and lateral fluoroscopic view showed the position of cage and pedicle system. (C, D) One-year postoperative coronal and sagittal computed tomography reconstruction showed solid interbody fusion.
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