Uniportal Full Endoscopic Posterolateral Transforaminal Lumbar Interbody Fusion with Endoscopic Disc Drilling Preparation Technique for Symptomatic Foraminal Stenosis Secondary to Severe Collapsed Disc Space: A Clinical and Computer Tomographic Study with Technical Note

Pang Hung Wu; Hyeun Sung Kim; Yeon Jin Lee; Dae Hwan Kim; Jun Hyung Lee; Jun Bok Jeon; Harshavardhan Dilip Raorane; Il-Tae Jang

doi:10.3390/brainsci10060373

Uniportal Full Endoscopic Posterolateral Transforaminal Lumbar Interbody Fusion with Endoscopic Disc Drilling Preparation Technique for Symptomatic Foraminal Stenosis Secondary to Severe Collapsed Disc Space: A Clinical and Computer Tomographic Study with Technical Note

Brain Sci. 2020 Jun 15;10(6):373. doi: 10.3390/brainsci10060373.

Authors

Pang Hung Wu^{1

2}, Hyeun Sung Kim¹, Yeon Jin Lee¹, Dae Hwan Kim¹, Jun Hyung Lee¹, Jun Bok Jeon¹, Harshavardhan Dilip Raorane¹, Il-Tae Jang¹

Affiliations

¹ Spine Surgery, Nanoori Gangnam Hospital, Seoul 06048, Korea.
² National University Health System, JurongHealth Campus, Orthopaedic Surgery, Singapore 609606, Singapore.

Abstract

Background: Severe collapsed disc secondary to degenerative spinal conditions leads to significant foraminal stenosis. We hypothesized that uniportal posterolateral transforaminal lumbar interbody fusion with endoscopic disc drilling technique could be safely applied to the collapsed disc space to improve patients' pain score, restore disc height, and correct the segmental angular parameters.

Methods: We included patients who met the indication criteria for lumbar fusion and underwent uniportal full endoscopic posterolateral transforaminal lumbar interbody fusion with pre-operative Computer Tomography mid disc height of less than or equal to 5 mm and MRI of Grade 3 Foraminal Stenosis. Visual analogue scale and computer tomography pre-operative and post-operative sagittal disc height in the anterior, middle and posterior part of the disc; sagittal focal segmental angle; mid coronal disc height and coronal wedge angles were evaluated.

Results: 30 levels of Endo-TLIF were included, with a mean follow up of 12 months. The mean improvement in decreasing pain score was 2.5 ± 1.1, 3.2 ± 0.9 and 4.3 ± 1.0 at 1 week post operation, 3 months post operation and at final follow up, respectively, p < 0.05. There was significant increase in mid sagittal computer tomographic anterior, middle and posterior disc height of 6.99 ± 2.30, 6.28 ± 1.44, 5.12 ± 1.79 mm respectively, p < 0.05. CT mid coronal disc height showed an increase of 7.13 ± 1.90 mm, p < 0.05. There was a significant improvement in the CT coronal wedge angle of 2.35 ± 4.73 and the CT segmental focal sagittal angle of 1.98 ± 4.69, p < 0.05.

Conclusion: Application of Uniportal Endoscopic Posterolateral Lumbar Interbody Fusion in patients with severe foraminal stenosis secondary to severe collapsed disc space significantly relieved patients' pain and restored disc height without early subsidence or exiting nerve root dysesthesia in our cohort of patients.

Keywords: degenerative spine disease; endoscopic lumbar interbody fusion; endoscopic spine surgery; spinal fusion; transforaminal lumbar interbody fusion.