Awake Endoscopic Transforaminal Lumbar Interbody Fusion: A Technical Note

Abstract

Background

Advances in modern spinal fusion techniques have allowed for less peri-operative morbidity and more rapid recovery from surgery. The addition of endoscopy to minimally invasive surgery (MIS) fusion techniques represents the latest progression of efforts to minimize the impact of surgical intervention.

Technique

MIS transforaminal lumbar interbody fusion (TLIF) is performed endoscopically through a sub-centimeter working portal. Patients undergo light conscious sedation and remain awake to facilitate feedback with the surgeon and enhance post-operative recovery.

Results

Previously reported results of the first 100 cases performed by the senior author at a single institution are summarized. This cohort has been characterized by brief post-operative length of stay, low complication profile, and marked improvement in patient-reported outcomes scores, with no cases of pseudarthrosis at 1-year follow up.

Conclusions

The latest technical considerations and adaptations of a novel technique for endoscopic MIS spinal fusion without general anesthesia are described. A refined surgical technique and anesthetic protocol are presented in detail with recommendations for the successful implementation and performance of the procedure.

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Authors

Corresponding author

Correspondence to Alexander J. Butler MD.

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Conflict of Interest

Alexander J. Butler, MD, and G. Damian Brusko, BS, declare that they have no conflicts of interest. Michael Y. Wang, MD, reports royalties from DePuy-Synthes Spine, Inc., Children’s Hospital of Los Angeles, Springer Publishing, and Quality Medical Publishing; personal fees as a consultant from DePuy-Synthes Spine, Inc., JoiMax USA, K2M, and Aesculap Spine; advisory board membership for Vallum; stock in Spinicity and Innovative Surgical Devices; and grants from the US Department of Defense.

Human/Animal Rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2013.

Informed Consent

Informed consent was waived from all patients for being included in this study.

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Butler, A.J., Brusko, G.D. & Wang, M.Y. Awake Endoscopic Transforaminal Lumbar Interbody Fusion: A Technical Note. HSS Jrnl 16, 200–204 (2020). https://doi.org/10.1007/s11420-020-09748-6

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Keywords

  • fusion
  • spinal surgery
  • endoscopy
  • MIS
  • TLIF
  • technique