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Research ArticleEndoscopic Minimally Invasive Surgery

Feasibility of Full Percutaneous Segmental Stabilization of the Lumbar Spine With a Combination of an Expandable Interbody Cage and an Interspinous Spacer: Preliminary Results

Rudolf Morgenstern and Christian Morgenstern
International Journal of Spine Surgery November 2018, 5083; DOI: https://doi.org/10.14444/5083
Rudolf Morgenstern
Morgenstern Spine Institute, Centro Médico Teknon, Barcelona, Spain
MD, PHD
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Christian Morgenstern
Morgenstern Spine Institute, Centro Médico Teknon, Barcelona, Spain
MD, PHD
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ABSTRACT

Introduction We evaluated the feasibility of a full percutaneous approach with an expandable interbody cage and an interspinous spacer for a segmental stabilization of the anterior and posterior columns of the lumbar spine, respectively, with local anesthesia.

Methods Patients were prospectively included between 2012 and 2018 in this single-center, feasibility case series. An expandable interbody cage was inserted with endoscopy-based, facet-sparing percutaneous transforaminal lumbar interbody fusion (pTLIF). An interspinous spacer was percutaneously placed through the same skin incision. Pre- and postoperative Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) outcomes at 1, 3, 6, 12, and 24 months were obtained and evaluated with the Student t test. Postoperative outcome was classified according to modified Macnab criteria.

Results A total of 16 patients were included, presenting mean preoperative scores for VAS back of 6.9 ± 2.5, VAS leg 7.9 ± 1.2, and ODI 30.1 ± 4.5. Postoperative mean scores for VAS back of 1.9 ± 2.1, VAS leg 2.1 ± 3.4, and ODI 14.8 ± 13.0 significantly (P < .001) decreased with a mean follow-up of 18.1 ± 16.6 months (range 1-65.2). Postoperative outcome was excellent and good for 13 (81%) cases, fair for 2 (13%), and poor for 1 (6%) case with a preoperative spondylolisthesis, which required revision surgery due to persisting instability. Postoperative complications included 3 cases with transitory, ipsilateral dysesthesia and 2 cases with radiologic cage subsidence but no clinical symptoms. Median postoperative time until hospital discharge was 16 hours.

Conclusion Our preliminary results for this full percutaneous technique show a similar outcome compared to conventional surgery with a fast patient recovery and early postoperative hospital discharge, opening the way to instrumented, outpatient surgery.

  • expandable interbody cage
  • interspinous spacer
  • percutaneous surgery
  • percutaneous transforaminal lumbar interbody fusion

Footnotes

  • Disclosures and COI: The first author reports royalty fees from DePuy/Synthes and Interventional Spine Inc, and royalty fees from Joimax GmbH outside of the submitted work. The second author reports no conflict of interests.

  • ©International Society for the Advancement of Spine Surgery
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International Journal of Spine Surgery: 19 (S2)
International Journal of Spine Surgery
Vol. 19, Issue S2
1 Apr 2025
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Feasibility of Full Percutaneous Segmental Stabilization of the Lumbar Spine With a Combination of an Expandable Interbody Cage and an Interspinous Spacer: Preliminary Results
Rudolf Morgenstern, Christian Morgenstern
International Journal of Spine Surgery Nov 2018, 5083; DOI: 10.14444/5083

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Feasibility of Full Percutaneous Segmental Stabilization of the Lumbar Spine With a Combination of an Expandable Interbody Cage and an Interspinous Spacer: Preliminary Results
Rudolf Morgenstern, Christian Morgenstern
International Journal of Spine Surgery Nov 2018, 5083; DOI: 10.14444/5083
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Keywords

  • expandable interbody cage
  • interspinous spacer
  • percutaneous surgery
  • percutaneous transforaminal lumbar interbody fusion

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