Biportal Endoscopic Transforaminal Lumbar Interbody Fusion with Arthroscopy
- Affiliations
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- 1Department of Orthopedic Surgery, Andong Medical Center, Andong, Korea.
- 2Department of Spine Surgery, Barun Hospital, Jinju, Korea. djchoi9@hanmail.net
- KMID: 2411752
- DOI: http://doi.org/10.4055/cios.2018.10.2.248
Abstract
- Lumbar spine fusion has been widely accepted as a treatment for various spinal pathologies, including the degenerative spinal diseases. Transforaminal interbody fusion (TLIF) using minimally invasive surgery (MIS-TLIF) is well-known for reducing muscle damage. However, the need to use a tubular retractor during MIS-TLIF may contribute to some limitations of instrument handling, and a great deal of difficulty in confirming contralateral decompression and accurate endplate preparation. Several studies in spinal surgery have reported the use of the unilateral biportal endoscopic spinal surgery (technique for decompression or discectomy). The purpose of this study is to describe the process of and technical tips for TLIF using the biportal endoscopic spinal surgery technique. Biportal endoscopic TLIF is similar to MIS-TLIF except that there is no need for a tubular retractor. It is supposed to be another option for alternating open lumbar fusion and MIS fusion in degenerative lumbar disease that needs fusion surgery.
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Figure
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Fig. 1 Intraoperative arthroscopic images obtained during biportal endoscopic transforaminal lumbar interbody fusion. (A) Laminectomy using an osteotome for autologous bone harvest. (B) Ostectomy of the inferior articular process. (C) Removal of the foraminal ligament after facetectomy. (D) Disc incision using a biportal endoscopic specialized knife for discectomy.
Fig. 2 (A) Intraoperative arthroscopic view showing the intervertebral disc space with the cartilaginous endplate completely removed. (B) Intraoperative fluoroscopy. Bone grafting is performed using a specialized funnel in the biportal endoscopic transforaminal lumbar interbody fusion. (C) Intraoperative photograph. Fluoroscopy is used when bone grafting is performed.
Fig. 3 (A, B) Intraoperative photographs. When the cage is inserted, two semitubular retractors are used to protect the traversing and exiting roots. (C, D) Intraoperative anteroposterior and lateral views of fluoroscopy. The cage is inserted under the fluoroscopic guidance. (E) The portal locations of three different biportal endoscopic approaches. P: pedicle, IPA: ipsilateral posterior approach, TLIF: transforaminal lumbar interbody fusion, FLA: far lateral approach.