Article Figures & Data
Figures
- Figure 1
Operative images demonstrating endoscopic lateral lumbar interbody fusion procedure. (A) The patient is positioned in the lateral position with the surgeon demonstrated holding the endoscope and performing the discectomy with fluoroscopic and endoscopic visualization. (B) The endoscope and endoscopic grasper are used to retrieve iliac crest graft for packing the interbody titanium cage. (C) The titanium cage being packed with iliac crest autograft. (D and E) The titanium cage delivery over a nitinol blunt-tip wire is demonstrated, with zoomed-in details shown in (D) and zoomed-out views presented in (E).
- Figure 2
Endoscopic lateral lumbar fusion of L4-5. (A–C) Sagittal T2 magnetic resonance images (MRIs) from right (A), midline (B), and left (C), demonstrating grade 1 spondylolisthesis and severe left foraminal narrowing. (D–F) Axial T2 MRI of the lumbar spine demonstrating severe L4-5 foraminal narrowing in axial images from the bottom of the L4 endplate (D), through the L4-5 disc (E), and through the top of the L5 endplate (F). (G and H) Anteroposterior and lateral fluoroscopic images demonstrate the final position of the lateral interbody fusion device and pedicle screw instrumentation.
- Figure 3
Step-by-step endoscopic lateral lumbar fusion (ELLIF) of L4-5. (A–R) Anteroposterior (AP) and lateral fluoroscopic intraoperative images of the key operative ELLIF procedure. (A) AP fluoroscopic image demonstrates the beveled tubular retractor placed through the psoas, and the endoscopic grasper is shown performing the discectomy. (B) AP fluoroscopic image demonstrating the endoscopic curette preparing the endplate for arthrodesis. (C and D) Joimax EndoLIF titanium interbody cage is introduced into the disc space over a nitinol wire. (E and F) Lateral fluoroscopic images demonstrate the placement of the interbody cage with the wire (E) and then with the wire removed (F).(G and H) AP fluoroscopic images of the Jamshidi needle used for placement of the K-wires in the L4 pedicles (G) and L5 pedicles (H). (I) AP fluoroscopic image of the wire placement. (J–M) Lateral fluoroscopic images demonstrate the endoscopic right lumbar L4-5 lateral recess stenosis decompression and discectomy. (J) Endoscopic Shrill drill shown decompressing the lateral recess. (K) Endoscopic Kerrison rongeur shown completing the lateral recess stenosis decompression. (L and M) Lateral fluoroscopic images demonstrating the endoscopic grasper beginning (L) and completing (M) the discectomy as part of the lateral recess decompression. (N and O) AP fluoroscopic images demonstrate iliac crest graft harvesting. (N) Wire cannulates the iliac crest. (O) Crown reamer after placement over dilator shown harvesting iliac crest though ELLIF incision. (P and Q) Lateral fluoroscopic images demonstrate percutaneous pedicle screw placement over the wires. (R) Final AP fluoroscopic image of the fusion construct.
- Figure 4
Endoscopic lateral lumbar fusion of L3-5. Sagittal T2 magnetic resonance image (MRI) reveals severe right L3-4 foraminal narrowing and endplate changes at L3-4 (A is paracentral and B is foraminal) (open arrows) as well as severe left L4-5 foraminal narrowing and endplate changes at L4-5 (C is foraminal and D is paracentral) (open arrows). (E and F) Axial T2 MRIs of the right L3-4 foraminal narrowing (E, open arrow) and the left L4-5 foraminal narrowing (F, open arrow). (G and H) AP and lateral fluoroscopic images demonstrate the final position of the lateral interbody fusion devices and pedicle screw instrumentation.
- Figure 5
Endoscopic lateral lumbar fusion of L3-5. (A) Sagittal T2 magnetic resonance image (MRI) demonstrates moderate right L3-4 and severe right L4-5 foraminal narrowing (open arrows). (B and C) Axial T2 MRI demonstrates moderate bilateral L3-4 (B) and severe bilateral L4-5 (C) foraminal narrowing. (D and E) Anteroposterior and lateral fluoroscopic images demonstrate the final position of the lateral interbody fusion devices and pedicle screw instrumentation.
Tables
- Table 1
Summary of postoperative changes in VAS and ODI scores at 1-month and 2-year follow-up.
Case VAS ODI Preoperative 1 mo 2 y % Change Preoperative 1 mo 2 y % Change 1 8 4 2 75% 32 22 10 69% 2 10 4 2 80% 42 19 10 76% 3 10 6 1 90% 46 28 5 89% Mean 9.3 4.7 1.7 82% 40 23 8.3 78% Abbreviations: ODI, Oswestry Disability Index; VAS, visual analog scale.
Case Time in Hospital, h Return to Normal Daily Activity, d Complications 1 48 60 None 2 24 40 None 3 36 45 None Mean 36 48 NA Abbreviation: NA, not applicable.
In this issue
