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Lumbar interbody fusion with bilateral cages using a biportal endoscopic technique with a third portal

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Abstract

Background

Unilateral biportal endoscopic lumbar interbody fusion (ULIF) with one cage results in fewer definitive fusions (Park et al. in Neurosurg Rev 42(3):753–761, 2019). We succeeded in inserting bilateral cages during ULIF.

Method

We attempted posterior ULIF for degenerative lumbar spondylolisthesis with bilateral recess stenosis. With the help of a third portal, ULIF with bilateral cage insertion was performed under general anaesthesia.

Conclusions

We successfully performed ULIF with bilateral cages with the help of a third portal. This procedure may be an alternative for treating lumbar stenosis with 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).

Author information

Author notes

  1. The authors Chengyue Zhu and Liangping Zhang contributed equally to this work and should be considered co-first authors.

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, Hao Pan & Wei Zhang

  2. Department of Orthopaedics, Hangzhou Linan TCM Hospital, Linan Xishui North Road No. 288, Hangzhou, 311300, China

    Chengyue Zhu

  3. Zhejiang Chinese Medical University, Binwen Road No. 548, Hangzhou, 310053, China

    Liangping Zhang

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

Correspondence to Wei Zhang.

Ethics declarations

Ethics approval and consent to participate

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 ULIF with bilateral cages using a biportal endoscopic posterior approach with the help of a third portal.

2. Compared with conventional standard PLIF, the benefits of ULIF with bilateral cages included the preservation of the muscles and ligaments, reduced transfusion requirements [4], and enhanced postoperative recovery [2].

3. Zhang’s portal was designed over the base of the contralateral SAP, which provided accessibility to decompress the recess and implant the cage.

4. Through Zhang’s portal, surgical tools can be used perpendicular to the spine so that contralateral decompression is not blocked by the base of the spinous process, allowing a more convenient and flexible operation (Fig. 

Fig. 5
figure 5

a The Kerrison punch is blocked by the base of the spinous process; b Through Zhang’s portal, an efficient contralateral decompression can be achieved; c The forceps cannot resect the contralateral LF because of obstruction of the base of the spinous process; d Through Zhang’s portal, the contralateral LF can be removed easily

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5).

5. Contralateral decompression can also cause adhesion lysis, which is helpful for reduction in lumbar spondylolisthesis.

6. When inserting the contralateral cage, a retractor should be inserted through the working portal to protect the contralateral traversing nerve root.

7. The quarterback K portal was placed only at the junction of the inferior lamina of the superior vertebrae and the base of the spinous process. A Kirschner wire was used as a root retractor through the quarterback K portal and did not hinder the use of the surgical instruments in the working portal, increasing the safety of the procedure and the comfort of the assistant.

8. The Kirschner wire should not be inserted too deep to prevent damage to the abdominal organs.

9. After inserting the contralateral cage, it is necessary to confirm its location through endoscopy and fluoroscopy.

10. Bilateral drainage tubes should be inserted through the quarterback K portal and Zhang’s portal to avoid epidural haematoma.

This article is part of the Topical Collection on Spine degenerative

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Zhu, C., Zhang, L., Pan, H. et al. Lumbar interbody fusion with bilateral cages using a biportal endoscopic technique with a third portal. Acta Neurochir 164, 2343–2347 (2022). https://doi.org/10.1007/s00701-022-05324-5

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  • DOI: https://doi.org/10.1007/s00701-022-05324-5

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