Ono Koichiro, Fukuhara Daisuke, Nagahama Ken, Abe Yuichiro, Takahashi Kenji, Majima Tokifumi
Department of Orthopedic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan.
Department of Orthopedic Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan.
J Clin Med. 2023 Aug 19;12(16):5391. doi: 10.3390/jcm12165391.
Full endoscopic techniques are becoming more popular for degenerative lumbar pathologies. Percutaneous endoscopic lumbar interbody fusion (PETLIF) is a minimally invasive surgical technique for spondylolisthesis and lumbar spinal canal stenosis with instability. Nagahama first introduced PETLIF in 2019. This study investigated the clinical outcomes and complications of 24 patients who underwent PETLIF in our facility and compared them with previous studies. Literature searches were conducted on PubMed and Web of Science. The PETLIF surgical technique involves three steps to acquire disc height under general anesthesia. The procedure includes bone harvesting, spondylolisthesis reduction, endoscopic foraminoplasty, disc height expansion using an oval dilator, and intervertebral disc curettage. A cage filled with autologous bone is inserted into the disc space and secured with posterior fixation. Patients underwent PETLIF with an average operation time of 130.8 min and a blood loss of 24.0 mL. Postoperative hospital stays were 9.5 days. Improvement in VAS, disc height, spinal canal area, and % slip was observed, while lumbar lordosis remained unchanged. Complications included end plate injury, subsidence, and exiting nerve root injury. The differences between PETLIF and the extracted literature were found in patients' age, direct decompression, epidural or local anesthesia, approach, order of PPS, and cage insertion. In conclusion, PETLIF surgery is a practical, minimally invasive surgical technique for patients with lumbar degenerative diseases suffering from back and leg pain, demonstrating significant improvements in pain scores. However, it is essential to carefully consider the potential complications and continue to refine the surgical technique further to enhance the safety and efficacy of this procedure.
全内镜技术在退行性腰椎疾病中越来越受欢迎。经皮内镜下腰椎椎间融合术（PETLIF）是一种用于治疗腰椎滑脱和伴有不稳的腰椎管狭窄症的微创手术技术。长滨于2019年首次引入PETLIF。本研究调查了在我们机构接受PETLIF治疗的24例患者的临床结果和并发症，并与先前的研究进行了比较。在PubMed和科学网进行了文献检索。PETLIF手术技术包括在全身麻醉下获取椎间盘高度的三个步骤。该手术包括取骨、腰椎滑脱复位、内镜下椎间孔成形术、使用椭圆形扩张器扩大椎间盘高度以及椎间盘刮除术。将填充自体骨的椎间融合器插入椎间盘间隙并用后路固定。患者接受PETLIF手术，平均手术时间为130.8分钟，失血量为24.0毫升。术后住院时间为9.5天。观察到视觉模拟评分（VAS）、椎间盘高度、椎管面积和滑脱百分比有所改善，而腰椎前凸保持不变。并发症包括终板损伤、下沉和出口神经根损伤。发现PETLIF与所提取文献之间在患者年龄、直接减压、硬膜外或局部麻醉、入路、经皮穿刺椎弓根螺钉固定顺序和椎间融合器插入方面存在差异。总之，PETLIF手术对于患有腰腿痛的腰椎退行性疾病患者来说是一种实用的微创手术技术，在疼痛评分方面有显著改善。然而，必须仔细考虑潜在的并发症，并继续进一步完善手术技术，以提高该手术的安全性和有效性。
