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Research ArticleArticles

Percutaneous Transforaminal Lumbar Interbody Fusion (pTLIF) with a Posterolateral Approach for the Treatment of Degenerative Disk Disease: Feasibility and Preliminary Results

Rudolf Morgenstern and Christian Morgenstern
International Journal of Spine Surgery January 2015, 9 41; DOI: https://doi.org/10.14444/2041
Rudolf Morgenstern
1Orthopedic Spine Surgery Unit (Morgenstern Spine Institute), Hospital Quirón Teknon, Barcelona, Spain
MD, PhD
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Christian Morgenstern
2Centrum für Musculoskeletale Chirurgie (CMSC), Department of Orthopedic Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
MD, PhD
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  • Article
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Article Figures & Data

Figures

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  • Fig. 1
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    Fig. 1

    Telescopic instrument with the three stages for posterolateral transforaminal disk access.

  • Fig. 2
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    Fig. 2

    Rigid PEEK cage fitting through a 12 mm access cannula (top) and same size expandable titanium cage, unexpanded (left) and fully expanded (right) (bottom).

  • Fig. 3
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    Fig. 3

    Posterolateral transforaminal 18G needle insertion under anteroposterior and lateral fluoroscopic control.

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    Fig. 4

    Bevelled cannula protecting the exiting nerve root.

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    Fig. 5

    Intradiscal titanium cage expansion.

  • Fig. 6
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    Fig. 6

    Postoperative fusion cage control by CT scan. Intradiscal rigid PEEK cage (left) and expanded titanium cage (right).

  • Fig. 7
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    Fig. 7

    Percentages of patients with excellent, good, fair, and poor results in the overall series of patients and subgroups of patients undergoing PEEK cage insertion (group A), expandable titanium cage as primary surgery (group B), and expandable titanium cage as revision surgery (group C).

  • Fig. 8
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    Fig. 8

    Final fluoroscopic anteroposterior and lateral control of the expandable titanium cage positioned at L4-L5 level.

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    Fig. 9

    Preoperative (left) and postoperative (right) CT scan showing distraction and reduction of a spondylolisthesis grade 1 at L5-S1 level.

  • Fig. 10
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    Fig. 10

    Preoperative spondylolisthesis L5-S1 grade II-III (A). Postoperative reduction after Opticage™ expansion and posterior screw fixation (B). Evidence of bony fusion 24 months after surgery (C).

Tables

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    Table 1

    Characteristics of Patients Undergoing Percutaneous Transforaminal Lumbar Interbody Fusion (PTLIF)

    DataNon-expandable PEEK interbody implantExpandable titanium interbody implant (n = 20)Total patients (n = 30)
    Primary surgery (group A) (n = 10)Primary surgery (group B) (n = 10)Revision surgery (group C) (n = 10)
    Sex
    Males43512
    Females67518
    Age, years, mean (SD)61.4 (17.4)59.9 (17.5)65.5 (12.9)62.2 (15.9)
    Total disks10111031
    Single level10101030
    Double level0101
    L2-L30112
    L3-L42013
    L4-L566517
    L5-S12439
    Spinal diseases
    DDD6309
    Spondylolisthesis46212
    Failed arthrodesis0066
    Instability after decompression0022
    Chondroma0101
    • View popup
    Table 2

    Individual Data of 10 Patients with Failed Back Surgery Syndrome Undergoing Percutaneous Transforaminal Lumbar Interbody Fusion (PTLIF)

    CasePrevious surgeryDisk levelsDiagnosisTreatmentFusion level
    1Posterior fixation 3 years agoL4-S1Screw looseningExpandable cageL5-S1
    2Decompression 4 years ago and posterior fusion 2 years agoL2-L5Broken bone graft + Spondylolisthesis L3-L4Expandable cage + posterior re-fixation L2-L5L3-L4
    3Percutaneous B-Twin fusion 6 years agoL5-S1Failed arthrodesisExpandable cage + posterior re-fixation L4-S1L5-S1
    4PLIF with posterior fixation and decompression 2 years agoL3-S1Adjacent segment syndromeExpandable cage + posterior re-fixation D12-L3L2-L3
    5Posterior decompression 1 year agoL4-S1Flat back syndromeExpandable cage + posterior re-fixation L4-S1L5-S1
    6Decompression with posterior fixation 3 years agoL3-L5Screw looseningExpandable cage + posterior re-fixation L3-L5L4-L5
    7Discectomy 17 years agoL4-L5Foraminal stenosisExpandable cage + posterior re-fixation L3-S1L4-L5
    8Posterior fixation with interbody PEEK cage 1 year agoL4-L5Foraminal stenosis + spondylolisthesisExpandable cageL4-L5
    9Posterior fixation L1-L4 11 years ago and posterior fixation L1-L5 1 year agoL3-S1Screw looseningExpandable cage + posterior re-fixation L4-S1L4-L5
    10Posterior fixation + decompression 6 months agoL4-L5Screw looseningExpandable cage + posterior re-fixation L4-L5L4-L5
    • PLIF: posterior lumbar interbody fusion.

    • View popup
    Table 3

    Results of Functional Assessments for Pain and Disability in 30 Patients Undergoing Percutaneous Transforaminal Lumbar Interbody Fusion (PTLIF).

    DataNon-expandable PEEK interbody implantExpandable titanium interbody implant (n = 20)Total patients (n = 30)
    Primary surgery (group A) (n = 10)Primary surgery (group B) (n = 10)Revision surgery (group C) (n = 10)
    Back pain, VAS scores, mean
    Preoperatively6.86.47.26.9
    Postoperatively (first week)4.2*5.0*4.9*4.8*
    Follow-up (mo)
    13.4*3.2*4.6*3.7*
    32.8*2.2*3.1*2.6*
    62.1*1.5*3.3*2.3*
    123.0*1.5*3.8*2.5*
    243.0*0.9*3.2*2.4*
    Leg pain, VAS scores
    Preoperatively7.27.37.47.4
    Postoperatively (first week)5.1*3.7*4.0*4.1*
    Follow-up (mo)
    13.7*2.4*3.0*2.8*
    32.3*1.4*1.7*1.5*
    61.7*1.8*1.0*1.3*
    121.3*1.82.0*1.4*
    241.3*0.2*1.0*0.8*
    ODI score, mean
    Preoperatively31.933.335.434.2
    Postoperatively (first week)23.4*25.4*27.3*25.3*
    Follow-up (monts)
    117.4*19.6*22.319.4*
    314.3*15.0*17.0*14.7*
    612.6*12.8*15.1*13.0*
    1212.0*11.5*15.8*12.0*
    2412.0*11.2*15.2*12.8*
    • ↵* P < 0.05 compared to preoperative values. VAS: visual analog scale. ODI: Oswestry Disability Index.

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International Journal of Spine Surgery
Vol. 9
1 Jan 2015
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Percutaneous Transforaminal Lumbar Interbody Fusion (pTLIF) with a Posterolateral Approach for the Treatment of Degenerative Disk Disease: Feasibility and Preliminary Results
Rudolf Morgenstern, Christian Morgenstern
International Journal of Spine Surgery Jan 2015, 9 41; DOI: 10.14444/2041

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Percutaneous Transforaminal Lumbar Interbody Fusion (pTLIF) with a Posterolateral Approach for the Treatment of Degenerative Disk Disease: Feasibility and Preliminary Results
Rudolf Morgenstern, Christian Morgenstern
International Journal of Spine Surgery Jan 2015, 9 41; DOI: 10.14444/2041
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  • Percutaneous Lumbar Interbody Fusion With an Expandable Titanium Cage Through Kambins Triangle: A Case Series With Initial Clinical and Radiographic Results
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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
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Keywords

  • minimally invasive surgery
  • degenerative disk disease
  • revision surgery
  • percutaneous transforaminal lumbar interbody fusion
  • expandable titanium interbody implant
  • transforaminal posterolateral approach

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