Biportal Endoscopic TLIF With an Expandable Cage: Technical Note and Preliminary Results in Terms of Segmental Lordosis Achievement and Disc Height Elevation.

IF 1.7 Q2 SURGERY International Journal of Spine Surgery Pub Date : 2024-11-08 DOI:10.14444/8680
Tae Hoon Kang, Minjoon Cho, Jae Hyup Lee
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引用次数: 0

Abstract

Background: Biportal endoscopic transforaminal lumbar interbody fusion (BE-TLIF) is a minimally invasive TLIF (MIS-TLIF) technique, commonly performed with various cage types. Expandable cages are particularly effective in achieving segmental lordosis (SL) and disc height (DH) elevation in minimally invasive TLIF. However, the published literature lacks details regarding how these outcomes can be accomplished using BE-TLIF with an expandable cage.

Methods: Nine cases (10 levels) of BE-TLIF with an expandable cage were reviewed. Procedures including unilateral laminotomy and bilateral decompression, cage expansion trials, and bilateral facetectomies were carried out under biportal endoscopy to achieve SL and DH elevation. Postoperative standing x-ray images at 3 months and reconstructed computed tomography images were analyzed. The sublaminar decompression angle-measured as the angle between the spinous process and the sublaminar decompression line on axial computed tomography-was used to evaluate contralateral sublaminar decompression.

Results: All procedures were completed without changes to the surgical methods. Eight patients underwent single-level fusion, with 4 of them receiving additional decompression at adjacent levels. One patient underwent a 2-level fusion. Four cases utilized 12° lordotic cages, while the rest employed 20° hyperlordotic cages. The total time for each fusion was 152.5 ± 38.5 minutes. Segmental lordosis increased by 5.1°, with anterior and posterior DH elevations of 4.8 ± 1.7 mm and 3.1 ± 1.8 mm, respectively. No endplate injuries or early cage subsidence occurred. The mean sublaminar decompression angle was 31.8° ± 7.0°.

Conclusions: BE-TLIF with an expandable cage may offer benefits in SL correction and DH elevation. These advantages are attributed to the use of more lordotic expandable cages, combined with contralateral facetectomies and careful endplate preparation-key features of the BE-TLIF technique.

Clinical relevance: SL correction and DH elevation can be achieved through BE-TLIF, which helps to reduce the recurrence of symptoms and improves the lumbar lordotic curve.

Level of evidence: 4:

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使用可扩张保持架的双腔内窥镜 TLIF:技术说明和节段脊柱前凸实现情况及椎间盘高度升高的初步结果。
背景:双门内窥镜经椎间孔腰椎椎体间融合术(BE-TLIF)是一种微创TLIF(MIS-TLIF)技术,通常使用各种类型的椎体笼。在微创 TLIF 术中,可膨胀保持架在实现节段前凸(SL)和椎间盘高度(DH)升高方面尤为有效。然而,已发表的文献中缺乏使用可扩张保持架的 BE-TLIF 如何实现这些结果的详细信息:方法:回顾了九例(10 个水平)使用可扩张保持架的 BE-TLIF 手术。在双侧内窥镜下进行了包括单侧椎板切除术和双侧减压术、骨笼扩张试验和双侧面骨切除术在内的手术,以实现SL和DH的抬高。分析了术后 3 个月的立位 X 光图像和重建计算机断层扫描图像。用椎板下减压角来评估对侧的椎板下减压情况,该角度是指椎突与轴向计算机断层扫描上的椎板下减压线之间的角度:所有手术均在未改变手术方法的情况下完成。八名患者接受了单水平融合术,其中四名患者在邻近水平接受了额外减压。一名患者接受了两级融合术。4例患者使用了12°脊柱前凸固定架,其余患者使用了20°脊柱后凸固定架。每次融合的总时间为 152.5 ± 38.5 分钟。椎节前凸增加了5.1°,前后DH分别升高了4.8 ± 1.7 mm和3.1 ± 1.8 mm。没有发生终板损伤或早期椎弓根下陷。平均椎板下减压角度为 31.8° ± 7.0°:结论:使用可扩张保持架的BE-TLIF可在SL矫正和DH抬高方面提供优势。这些优势归功于使用了更多的前凸型可扩张保持架,结合对侧椎板切除术和仔细的终板准备--BE-TLIF 技术的主要特点:临床相关性:通过 BE-TLIF 可以实现 SL 矫正和 DH 抬高,这有助于减少症状复发并改善腰椎前凸曲线:4:
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来源期刊
CiteScore
3.10
自引率
0.00%
发文量
162
期刊介绍: The International Journal of Spine Surgery is the official scientific journal of ISASS, the International Intradiscal Therapy Society, the Pittsburgh Spine Summit, and the Büttner-Janz Spinefoundation, and is an official partner of the Southern Neurosurgical Society. The goal of the International Journal of Spine Surgery is to promote and disseminate online the most up-to-date scientific and clinical research into innovations in motion preservation and new spinal surgery technology, including basic science, biologics, and tissue engineering. The Journal is dedicated to educating spine surgeons worldwide by reporting on the scientific basis, indications, surgical techniques, complications, outcomes, and follow-up data for promising spinal procedures.
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