Lara-Reyna Jacques, Margetis Konstantinos
Neurological Surgery, Mount Sinai Health System, New York, USA.
Cureus. 2021 Apr 6;13(4):e14327. doi: 10.7759/cureus.14327.
Background Facet fusion has been described in open and minimally invasive approaches to promote fusion. Our objective is to describe the technique of an endoscopic facet decortication and allograft placement as an adjunct to an interbody fusion. Methodology This was a descriptive analysis of patients who underwent endoscopic interbody fusion combined with facet fusion and percutaneous screw placement. General demographics, clinical presentation, length of stay, follow-up, and outcome were gathered. The technique involves endoscopic access to the Kambin's triangle, discectomy/endplate preparation, expandable cage/allograft insertion, and percutaneous pedicle screw placement. A midline incision was performed, and the endoscope was advanced over the facet joints at the desired level. After removing the soft tissue with grasping forceps, cautery was used to disrupt the facet capsule. An articulating high-speed bur was used to drill inside and over the dorsal surface of the joint. Finally, allograft chips were placed through the endoscope cannula. Results From May 2019 to December 2019, four patients underwent endoscopic interbody fusion. All were female, with a mean age of 67.5 years (SD: 12.7). All had chronic low back pain and radiculopathy associated with Grade 1 spondylolisthesis. Two (50%) of the patients underwent two-level fusion. The median hospital stay was two days. Two (50%) reported improvement of both low back and radiculopathy symptoms. None of the patients had a significant complication or required reoperation in eight months' mean follow-up. Conclusions Facet decortication and allograft placement are feasible using an endoscopic approach in conjunction with interbody fusion.
在开放手术和微创手术中，小关节融合已被用于促进融合。我们的目的是描述一种内镜下小关节去皮质和同种异体骨植入技术，作为椎间融合的辅助手段。方法：这是一项对接受内镜下椎间融合联合小关节融合及经皮螺钉置入患者的描述性分析。收集了一般人口统计学资料、临床表现、住院时间、随访情况及结果。该技术包括通过内镜进入Kambin三角、椎间盘切除术/终板准备、可扩张椎间融合器/同种异体骨植入以及经皮椎弓根螺钉置入。做一个中线切口，将内镜推进到所需节段的小关节上方。用抓钳去除软组织后，使用电灼破坏小关节囊。使用关节高速磨钻在关节内部和背侧表面钻孔。最后，通过内镜套管置入同种异体骨碎片。结果：2019年5月至2019年12月，4例患者接受了内镜下椎间融合术。均为女性，平均年龄67.5岁（标准差：12.7）。所有患者均有慢性下腰痛和与Ⅰ度椎体滑脱相关的神经根病。2例（50%）患者接受了两节段融合。中位住院时间为2天。2例（50%）患者报告下腰痛和神经根病症状均有改善。在平均8个月的随访中，所有患者均无明显并发症或需要再次手术。结论：在内镜下结合椎间融合进行小关节去皮质和同种异体骨植入是可行的。
