Park Hyun-Jin, Shin John I, You Ki-Han, Yang Jason I, Kim Nathan, Kim Yong H, Kang Min-Seok, Park Sang-Min
Department of Orthopedic Surgery, Spine Center, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, Seoul, South Korea.
Department of Orthopedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center-RWJBarnabas Health, Jersey, NJ, USA.
Int J Spine Surg. 2024 Nov 8;18(5):582-588. doi: 10.14444/8648.
Biportal endoscopic transforaminal lumbar interbody fusion (BE-TLIF) is a minimally invasive surgical technique for treating degenerative lumbar spine conditions. It offers advantages such as reduced soft tissue trauma and lower infection rates, but certain technical aspects may be challenging. The current study aims to identify strategies to enhance the fusion rate in BE-TLIF by addressing these specific challenges.
A literature review was conducted on techniques to improve fusion rates in BE-TLIF.
The review suggests that lateral-based portals supplemented with medial portals allowed for safe insertion of interbody cages with large footprint. Direct visualization of the disc space with a 30° endoscope assisted with better disc space preparation. Facetectomies performed with osteotomes, rather than burrs, ensured maximum retrieval of autologous bone graft. Utilizing bone morphogenetic proteins with sustained release carriers such as hydroxyapatite can be useful to increase fusion rates of BE-TLIF.
To our knowledge, the current literature is the first comprehensive review of strategies to enhance fusion rates in BE-TLIF. The proposed techniques and biological adjuncts are effective means to address key challenges associated with the procedure, and such strategies would potentially shorten the learning curve and improve clinical outcomes. Further clinical studies are required to validate these findings and establish standardized protocols.
These findings provide practical solutions to overcome common challenges in BE-TLIF. The suggested techniques would reduce the incidence of pseudarthrosis, improve patient outcomes, and ultimately offer a safer and more reliable option for lumbar interbody fusion patients.
双孔道内镜下经椎间孔腰椎椎间融合术（BE-TLIF）是一种用于治疗退行性腰椎疾病的微创手术技术。它具有软组织创伤小和感染率低等优点，但某些技术方面可能具有挑战性。本研究旨在通过应对这些特定挑战来确定提高BE-TLIF融合率的策略。
对提高BE-TLIF融合率的技术进行了文献综述。
综述表明，外侧入路辅以内侧入路可安全植入大尺寸椎间融合器。使用30°内镜直接观察椎间盘间隙有助于更好地准备椎间盘间隙。用骨刀而非磨钻进行椎板切除可确保最大限度地获取自体骨移植材料。使用载有骨形态发生蛋白的缓释载体（如羟基磷灰石）有助于提高BE-TLIF的融合率。
据我们所知，当前文献是对提高BE-TLIF融合率策略的首次全面综述。所提出的技术和生物辅助手段是应对与该手术相关的关键挑战的有效方法，这些策略可能会缩短学习曲线并改善临床结果。需要进一步的临床研究来验证这些发现并建立标准化方案。
这些发现为克服BE-TLIF中的常见挑战提供了切实可行的解决方案。所建议的技术将降低假关节形成的发生率，改善患者预后，并最终为腰椎椎间融合患者提供更安全、更可靠的选择。
