Feasibility of Endoscopic Transforaminal Lumbar Interbody Fusion (eTLIF) Through the Posterior Paraspinal Approach: Technical Note and Preliminary Result

Abstract

Objective The implement of endoscopic spinal surgery has minimized the requirement of fusion procedures. However, certain patients still require fusion surgery such as instability. We performed a full-endoscopic transforaminal lumbar interbody fusion (eTLIF) through a conventional paraspinal approach. Methods eighteen consecutive patients with degenerative lumbar disease underwent eTLIF through paraspinal approach. Their clinical outcomes were evaluated with visual analog scale (VAS), Oswestry Disability Index (ODI) and the MacNab's criteria; radiological outcome measured with segmental lordosis (SLA), global lumbar lordosis (LLA), disc height (DH) on plain radiograph and percentage of potential fusion mass on CT scan at pre-operative, post-operative and final follow up period. intra operative and post-operative complications noted. Results Mean age was 63. 71 years and Mean follow-up periods was 7.78 months. In the X-ray result, mean SLA improved in pre-operative/post-operative/follow-up period 9.87±2.740/11.79±3.74 0/10.56±3.690 (p>0.01); mean LLA improved 37.1±7.040/39.2±7.130/35.7±7.250 (p>0.01). Mean DH improved from 8.97±1.49 mm/12.34±1.39 mm/11.44±1.98 mm(p<0.01). In the CT result, Average percentage of fusion mass was 42.61%. VAS was improved, 7.67/3.39/2.5 and ODI was improved, 74.9/34.56/27.76 by each preoperative/postoperative/final follow-up. In the clinical result, excellent was 5 cases and good was 13 cases. Conclusion eTLIF was competent and viable surgical procedure. The results were excellent in the form of endplate preservation, disc height restoration, minimal post-operative pain with early mobilization. The fusion volume occupies 40% to 50% of disc space is expected to give sufficient fusion.

Keywords

• endoscopic tlif
• paraspinal approach
• feasibility
• end plate preservation