Casal Grau Ricardo, Sánchez Benitez de Soto Francisco Javier, Barhouse Patrick, Schroeder Christian, Leary Owen P, Sullivan Patricia Zadnik, Telfeian Albert E
Casal Dots SLU and Asepeyo Hospital, Madrid, Spain.
Asepeyo Traumatology and Rehabilitation Monographic Hospital, Coslada, Madrid, Spain.
Int J Spine Surg. 2024 Mar 4;18(1):101-109. doi: 10.14444/8572.
Our objective is to describe a minimally invasive endoscopic surgical technique for performing lateral lumbar interbody fusion (LLIF). LLIF is a common approach to lumbar fusion in cases of degenerative lumbar disease; however, complications associated with psoas and lumbar plexus injury sometimes arise. The endoscopic modification presented here diminishes the requirement for sustained muscle retraction, minimizing complication risk while allowing for adequate decompression in select cases.
Endoscopic LLIF (ELLIF) was performed in 3 patients from 2019 to 2021. Surgeries were performed in the lateral position under general anesthesia with neurophysiological monitoring. Discectomy, endplate preparation, and harvesting of iliac crest bone were performed through a working channel endoscope. The introduction of an interbody cage (Joimax EndoLIF) was performed over a nitinol blunt-tip wire (Joimax). No expandable blade retractors were required.
At 2-year follow-up of these 3 patients, the mean visual analog scale (VAS) score for leg pain improved from 9.3 to 1.7, and the mean Oswestry Disability Index (ODI) score improved from 40 to 8.3. There were no complications, readmissions, or recurrence of symptoms during the 2-year follow-up period. Patients spent an average of 36 hours in the hospital postoperatively and returned to normal daily activities after an average of 48 days.
A minimally invasive modification to the LLIF procedure is presented that offers several potential advantages due to the application of endoscopic techniques: reduced muscle retraction, smaller incision, and the opportunity to perform both indirect decompression and endoscopically visualized discectomy in the same fusion procedure.
The proposed endoscopic lateral lumbar interbody fusion and decompression is a minimally invasive technique that may provide patients with minimal complications, quick recovery, and good functional recovery.
我们的目的是描述一种用于进行腰椎外侧椎间融合术（LLIF）的微创内镜手术技术。LLIF是治疗退行性腰椎疾病时常用的腰椎融合方法；然而，有时会出现与腰大肌和腰丛损伤相关的并发症。本文介绍的内镜改良方法减少了持续肌肉牵拉的需求，在某些情况下，在将并发症风险降至最低的同时，仍能实现充分减压。
2019年至2021年期间，对3例患者实施了内镜下LLIF（ELLIF）。手术在全身麻醉和神经生理监测下于侧卧位进行。通过工作通道内镜进行椎间盘切除术、终板准备和髂嵴骨采集。通过镍钛诺钝头导丝（Joimax）置入椎间融合器（Joimax EndoLIF）。无需使用可扩张叶片牵开器。
对这3例患者进行2年随访时，腿痛的平均视觉模拟量表（VAS）评分从9.3改善至1.7，平均Oswestry功能障碍指数（ODI）评分从40改善至8.3。在两年随访期内，无并发症、再次入院或症状复发。患者术后平均住院36小时，平均48天后恢复正常日常活动。
本文介绍了一种对LLIF手术的微创改良方法，由于应用了内镜技术，该方法具有几个潜在优势：减少肌肉牵拉、切口更小，以及在同一融合手术中既能进行间接减压又能进行内镜直视下椎间盘切除术。
所提出的内镜下腰椎外侧椎间融合与减压术是一种微创技术，可为患者带来并发症少、恢复快和功能恢复良好的效果。
