Endoscopic Lateral Lumbar Interbody Fusion: Technical Note and Case Series

Ricardo Casal Grau; Francisco Javier Sánchez Benitez de Soto; Patrick Barhouse; Christian Schroeder; Owen P Leary; Patricia Zadnik Sullivan; Albert E Telfeian

doi:10.14444/8572

Endoscopic Lateral Lumbar Interbody Fusion: Technical Note and Case Series

Int J Spine Surg. 2024 Mar 4;18(1):101-109. doi: 10.14444/8572.

Authors

Ricardo Casal Grau^{1

2}, Francisco Javier Sánchez Benitez de Soto^{1

2}, Patrick Barhouse³, Christian Schroeder³, Owen P Leary³, Patricia Zadnik Sullivan³, Albert E Telfeian⁴

Affiliations

¹ Casal Dots SLU and Asepeyo Hospital, Madrid, Spain.
² Asepeyo Traumatology and Rehabilitation Monographic Hospital, Coslada, Madrid, Spain.
³ Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
⁴ Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, USA ATelfeian@Lifespan.org.

PMID: 38320807
DOI: 10.14444/8572

Abstract

Background: Our objective is to describe a minimally invasive endoscopic surgical technique for performing lateral lumbar interbody fusion (LLIF). LLIF is a common approach to lumbar fusion in cases of degenerative lumbar disease; however, complications associated with psoas and lumbar plexus injury sometimes arise. The endoscopic modification presented here diminishes the requirement for sustained muscle retraction, minimizing complication risk while allowing for adequate decompression in select cases.

Methods: Endoscopic LLIF (ELLIF) was performed in 3 patients from 2019 to 2021. Surgeries were performed in the lateral position under general anesthesia with neurophysiological monitoring. Discectomy, endplate preparation, and harvesting of iliac crest bone were performed through a working channel endoscope. The introduction of an interbody cage (Joimax EndoLIF) was performed over a nitinol blunt-tip wire (Joimax). No expandable blade retractors were required.

Results: At 2-year follow-up of these 3 patients, the mean visual analog scale (VAS) score for leg pain improved from 9.3 to 1.7, and the mean Oswestry Disability Index (ODI) score improved from 40 to 8.3. There were no complications, readmissions, or recurrence of symptoms during the 2-year follow-up period. Patients spent an average of 36 hours in the hospital postoperatively and returned to normal daily activities after an average of 48 days.

Conclusions: A minimally invasive modification to the LLIF procedure is presented that offers several potential advantages due to the application of endoscopic techniques: reduced muscle retraction, smaller incision, and the opportunity to perform both indirect decompression and endoscopically visualized discectomy in the same fusion procedure.

Clinical relevance: The proposed endoscopic lateral lumbar interbody fusion and decompression is a minimally invasive technique that may provide patients with minimal complications, quick recovery, and good functional recovery.

Keywords: endoscopic spine; lateral lumbar interbody fusion; indirect decompression; minimally invasive spine; radiculopathy.

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