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Far lateral lumbar interbody fusion with unilateral pedicle screw fixation and double traversing cages using a biportal endoscopic technique

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Abstract

Background

Transforaminal lumbar interbody fusion (TLIF) with a single cage and bilateral pedicle screw fixation results in decreased stability or increased risk of cage displacement Wang and Guo (Comput Methods Biomech Biomed Eng, 24(3):308–319, 6). We succeeded in inserting double traversing cages with unilateral pedicle screw fixation (UPSF) during far lateral TLIF using unilateral biportal endoscopy (UBE).

Method

We attempted far lateral UBE-TLIF through two small incisions for degenerative lumbar spondylolisthesis with unilateral stenosis. With the help of novel instruments, far lateral UBE-TLIF with double traversing cages and UPSF was performed under tracheal intubation anaesthesia.

Conclusions

We successfully performed far lateral UBE-TLIF with double traversing cages and UPSF. This procedure may be an alternative minimally invasive method for treating lumbar instability.

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References

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Funding

This work was supported by the National Key R&D Program of China (2019YFC0121400).

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Authors and Affiliations

  1. Department of Orthopaedics, Hangzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University, Tiyuchang Road No. 453, Hangzhou, 310007, China

    Chengyue Zhu, Jiaming Liang, Hao Pan & Wei Zhang

Authors
  1. Chengyue Zhu
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  2. Jiaming Liang
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  3. Hao Pan
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  4. Wei Zhang
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Corresponding author

Correspondence to Wei Zhang.

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Ethics approval

This study protocol was approved by the Research Ethics Board of our hospital. The patient signed a written informed consent form for enrolment in this study.

Conflict of interest

The authors declare no competing interests.

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Key points

1. We successfully performed far lateral TLIF with double traversing cages and UPSF using UBE with the help of novel instruments.

2. Compared with single-cage TLIF, the benefits of double traversing cages include better lumbar lordosis, a larger contact area between endplates, and higher immediate stability.

3. UPSF can obviously reduce blood loss, shorten the operation and lower medical costs while provide similar clinical improvement and outcomes of fusion rate and complications [1, 5, 7, 8].

4. The IAP should be removed first; otherwise, pieces harvested from the SAP will be difficult to remove.

5. By rotating the 30° endoscope to observe the surgical field, the endplate can be processed extensively and thoroughly.

6. Discs on both edges as well as disc pieces in the central area should be totally removed to allow the cages to rotate easily.

7. To make room for the second cage, the first cage should be deeply implanted.

8. It is of the utmost importance to verify the depth of the intervertebral space and distance between the first cage and posterior margin of the vertebral body intraoperatively.

9. If the distance between the traversing and exiting nerve roots is too narrow, the use of double traversing cages is a safer alternative than the use of an oblique lumbar interbody fusion cage.

10. Through the K portal, the Kirschner wire can be placed as a retractor, the impactor can be used to deepen and reposition the cage, and the drainage tube can be placed at the end of the procedure.

Supplementary Information

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Zhu, C., Liang, J., Pan, H. et al. Far lateral lumbar interbody fusion with unilateral pedicle screw fixation and double traversing cages using a biportal endoscopic technique. Acta Neurochir 165, 2165–2169 (2023). https://doi.org/10.1007/s00701-023-05702-7

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  • DOI: https://doi.org/10.1007/s00701-023-05702-7

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