Article Figures & Data
Figures
- Figure 1
Incisions for biportal endoscopic transforaminal lumbar interbody fusion with an expandable cage. Red solid lines: 2 longitudinal 1-cm incisions lateral to the pedicle margin for biportal endoscopic procedures and percutaneous pedicle screw placement. These are referred to as the cranial and caudal biportal incisions. Blue arrow line: a less than 1 cm longitudinal incision just lateral to the midline, known as the quarterback incision. Green dotted lines: 2 longitudinal 1-cm incisions lateral to the pedicle margin for contralateral percutaneous pedicle screw insertions.
- Figure 2
(A) Covered field of view of the 30° scope before laminotomy. (B) Covered field of view of the 30° scope after unilateral laminotomy and bilateral decompression. (C) Red arrow indicates additional facetectomy, discectomy, and cage insertion. (D) Blue line marks the quarterback incision, which can be used for the endoscope, additional ipsilateral discectomy, dura retraction, and drain insertion.
- Figure 3
Endoscopic view. (A) Decompressed central canal after unilateral laminotomy. (B) Contralateral sublaminar bony resection while preserving the spinous process. (C) Contralateral sublaminar partial facetectomy performed using an osteotome. (D) After ipsilateral total inferior articular process and partial superior articular process resection. (E) Discectomy performed through the caudal biportal incision and quarterback incision. (F) Endoscope insertion into the disc space to inspect endplate preparation via the quarterback incision.
- Figure 4
(A and B) C-arm images showing the cage expansion trial. (C and D) C-arm images of the real cage insertion and expansion. (E) Real cage insertion with dura protection using a root retractor via the quarterback incision. (F) Real cage expansion using a torque driver.
- Figure 5
(A) The sublaminar decompression angle: the angle between the spinous process and the bony contour of the decompressed contralateral sublaminar space. (B) Axial computed tomography (CT) image of biportal endoscopic transforaminal lumbar interbody fusion (TLIF) at L4–L5 with an expandable cage. The sublaminar decompression angle is 36°. (C) Axial CT image of tubular minimally invasive TLIF at L4–L5 with an expandable cage. Only ipsilateral facetectomy was performed, and the sublaminar decompression angle is 8°.
- Figure 6
(A and B) Preoperative and postoperative 3-month lumbar standing lateral x-ray images. (C and D) Preoperative and postoperative 3-month lumbar standing anteroposterior x-ray images. (E and F) Preoperative and postoperative 6 weeks magnetic resonance images (MRIs), sagittal cut. (G and H) Preoperative and postoperative 6 weeks MRIs, axial cut of endoscopic fusion level, L4–L5.
Tables
Case Level Age, y Sex Height, cm Weight, kg BMI ASA Osteoporosis HbA1c Preoperative Diagnosis Revision Disc Height, mm Listhesis Grade, mm Kissing Spine PI, ° PT, ° LL, ° PI-LL Mismatch, ° 1 1 68 F 151.3 55.60 24.29 2 O 6.70 Degenerative spondylolisthesis L4–L5 with spinal stenosis (schiza D) X 6.5 1 (6) O 39.8 13.8 52.0 −12.2 2 2 81 M 161 65.00 25.10 2 O 5.90 Degenerative spondylolisthesis L4–L5 with spinal stenosis (schiza D) X 10.9 1 (5) O 47.2 15.0 50.0 −2.8 3 3 72 M 164.6 64.25 24.40 2 X 6.50 Degenerative spondylolisthesis L4–L5 with spinal stenosis (schiza D) X 10.9 1 (5) O 43.6 11.5 54.0 −10.4 4 4 70 M 168.9 83.70 29.30 2 X 6.80 Foraminal stenosis, L5–S1 X 12.4 0 O 47.1 24.0 44.6 2.5 5 5 79 F 147.3 41.80 19.27 2 O 6.20 Degenerative spondylolisthesis L3–L4 with spinal stenosis (schiza D) X 10.1 1 (3) O 52.3 23.8 54.2 −1.9 6 6 65 F 157 49.10 19.92 1 X 5.50 Foraminal stenosis, L4–L5 O 2.7 0 O 38.4 12.3 31.9 6.5 7 7 69 F 148 51.70 23.60 2 X 5.20 Foraminal stenosis L5–S1 O 12.0 0 O 44.1 28.3 20.1 24.0 8 8 78 F 147.8 43.80 20.05 2 O 5.80 Degenerative spondylolisthesis L3–L4 with spinal stenosis (schiza D) X 9.6 1 (2) O 57.7 26.9 36.1 21.6 9 9 72 F 153 68.7 29.35 2 X 6.20 Degenerative spondylolisthesis with L2–L3 spinal stenosis (schiza D) X 7.9 1 (5) O 35.3 12.7 29.2 6.1 10 Degenerative spondylolisthesis with L3–L4 spinal stenosis (schiza D) 11.1 1 (7) O 6.1 Totala 72.6 ± 5.2 M (3)/F (6) 155.2
± 7.559.2
± 13.124.5 ± 3.9 1 (1)/2 (8) O (4)/X (5) 6.1 ± 0.5 Spondylolisthesis (7)/foraminal stenosis (3) O (2)/X (7) 9.4 ± 3.0 O (10) 44.1 ± 12.4 18.1 ± 6.8 40.1
± 12.44.0 ± 11.9 Abbreviations: ASA, American Society of Anesthesiologists; BMI, body mass index; HbA1c, hemoglobin A1c; LL, lumbar lordosis; PI, pelvic incidence; PT, pelvic tilt.
Note: O indicates present, X indicates absent.
↵a Data presented as mean ± SD or (n).
Case Level Fusion Level Adjacent Decompression Operation Total Operation Time, min Total Time for ULBD and Cage Insertion, min Cage Size, mm Cage Angle, ° Segmental Lordosis Correction, ° LL Increase, ° Anterior Disc Height Elevation, mm Posterior Disc Height Elevation, mm Disc Height Elevation, mm Slip Reduction, mm Final PI-LL, ° PT Change, ° Sublaminar Decompression Angle, ° Endplate Injury 1 1 L4–L5 X 295 192 32 12 1.0 1.0 5.30 6.30 4.40 5.2 −13.2 −2.0 31 X 2 2 L4–L5 O (L3–L4) 287 165 28 12 5.5 4.8 4.10 1.60 3.20 4.0 −7.6 1.1 36 X 3 3 L4–L5 X 213 162 28 20 1.0 5.3 4.10 1.40 2.60 1.5 −15.7 0.4 36 X 4 4 L5–S1 X 282 209 28 20 −1.0 0.1 4.30 2.80 1.00 0 2.4 −5.1 14 X 5 5 L3–L4 O (L2–L3) 235 128 28 12 6.0 2.5 5.40 1.80 2.90 1.7 −4.4 1.4 33 X 6 6 L4–L5 O (L3–L4) 260 152 28 12 8.0 3.6 9.40 5.20 8.00 0 2.9 −2.8 32 X 7 7 L5–S1 O (L3–L4) 318 186 28 20 9.3 1.5 3.60 2.80 3.20 0 22.5 −5.1 38 X 8 8 L3–L4 X 275 136 28 20 4.0 0.3 3.50 1.00 1.70 4.0 21.3 −1.4 38 X 9 9 L2–L3 X 348 89 28 20 3.2 5.4 3.80 4.30 4.30 3.4 0.7 −2.0 32 X 10 L3–L4 X 106 28 20 14.0 4.60 3.50 3.40 3.7 28 X Total L2–L3 (1)
L3–L4 (3)
L4–L5 (4)
L5–S1 (2)O (4)/X (6) 286.1
± 44.1152.5
± 38.228 (9)/32 (1) 12 (4), 20 (6) 5.1
± 4.53.0
± 2.24.8
± 1.73.1
± 1.83.5
± 1.52.9
± 2.31.0
± 12.8−1.8
± 2.331.8
± 7.0X (10) Abbreviations: LL, lumbar lordosis; PI, pelvic incidence; PT, pelvic tilt; ULBD, unilateral laminotomy with bilateral decompression.
Note: O indicates present, X indicates absent.
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