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Modified far lateral endoscopic transforaminal lumbar interbody fusion using a biportal endoscopic approach: technical report and preliminary results

  • How I Do it - Spine degenerative
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Abstract

Background

Endoscopic transforaminal lumbar interbody fusion (TLIF) has the disadvantage of the small cage size and by consequence risk for cage subsidence. We succeeded to insert a large oblique lumbar interbody fusion (OLIF) cage during biportal endoscopic TLIF.

Methods

Unilateral total facetectomy was performed to expose the exiting and traversing nerve roots. The distance between the exiting and traversing nerve roots was measured before OLIF cage insertion. We inserted an OLIF cage instead of a TLIF cage.

Conclusion

We successfully performed modified far lateral biportal endoscopic TLIF using large OLIF cages. Modified far lateral biportal endoscopic TLIF is usually suitable for the L4-5 and L5-S1 levels.

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Author information

Authors and Affiliations

  1. Department of Neurosurgery and Orthopedics, Endoscopic Spine Surgery Center, Seoul Bumin Hospital, Seoul, South Korea

    Dong Hwa Heo, Jae Young Jo & Hungtae Chung

  2. Department of Neurosurgery, Spine Center, Medrex Hospital, 705, Nonhyeon-ro, Gangnam-gu, Seoul, 06046, South Korea

    Jin Hwa Eum

Authors
  1. Dong Hwa Heo
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  2. Jin Hwa Eum
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  3. Jae Young Jo
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  4. Hungtae Chung
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Corresponding author

Correspondence to Jin Hwa Eum.

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The authors declare no competing interests.

Additional information

Key points

1. Modified far lateral biportal endoscopic TLIF may be an alternative treatment method for lumbar degenerative disease.

2. The indications for modified far lateral TLIF were similar to minimally invasive TLIF or endoscopic TLIF.

3. Central decompressive procedures and total facetectomy may make enough space for the insertion of an OLIF or DLIF cage.

4. Modified far lateral biportal endoscopic TLIF may have limitations for upper lumbar lesions (from L1-2 to L3-4) due to the anatomical characteristics of these levels, including a relatively short distance between the traversing and exiting nerve roots.

5. Preoperative measurement of the distance between the traversing and exiting nerve roots using axial MRI views was important for determining the feasibility of far lateral biportal endoscopic TLIF.

6. If there was not enough space between the traversing and exiting nerve roots, we inserted the usual TLIF cage.

7. Endoscopic endplate preparation may be an advantage of endoscopic TLIF. The cartilaginous endplate can be completely removed without the osseous endplate under a magnified endoscopic view.

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Heo, D.H., Eum, J.H., Jo, J.Y. et al. Modified far lateral endoscopic transforaminal lumbar interbody fusion using a biportal endoscopic approach: technical report and preliminary results. Acta Neurochir 163, 1205–1209 (2021). https://doi.org/10.1007/s00701-021-04758-7

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  • DOI: https://doi.org/10.1007/s00701-021-04758-7

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