Kang Tae Hoon, Cho Minjoon, Lee Jae Hyup
Department of Orthopedic Surgery, SMG-SNU BRM Medical Center, Seoul, South Korea.
Department of Orthopedic Surgery, Seoul National University, College of Medicine, Seoul, South Korea.
Int J Spine Surg. 2024 Nov 8;18(5):571-581. doi: 10.14444/8680.
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.
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.
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°.
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.
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.
双门内镜经椎间孔腰椎椎间融合术（BE-TLIF）是一种微创TLIF（MIS-TLIF）技术，通常使用各种类型的椎间融合器进行。可扩张椎间融合器在微创TLIF中实现节段性前凸（SL）和椎间盘高度（DH）提升方面特别有效。然而，已发表的文献缺乏关于如何使用带可扩张椎间融合器的BE-TLIF来实现这些结果的详细信息。
回顾了9例（10个节段）采用可扩张椎间融合器的BE-TLIF病例。在双门内镜下进行包括单侧椎板切开和双侧减压、椎间融合器扩张试验以及双侧关节突切除等操作，以实现SL和DH提升。分析术后3个月的站立位X线片图像和重建的计算机断层扫描图像。通过在轴向计算机断层扫描上测量棘突与椎板下减压线之间的角度来评估对侧椎板下减压的椎板下减压角度。
所有手术均顺利完成，手术方法未作改变。8例患者接受单节段融合，其中4例在相邻节段进行了额外减压。1例患者接受了双节段融合。4例使用12°前凸椎间融合器，其余使用20°过度前凸椎间融合器。每次融合的总时间为152.5±38.5分钟。节段性前凸增加5.1°，前后DH分别提升4.8±1.7mm和3.1±1.8mm。未发生终板损伤或早期椎间融合器下沉。平均椎板下减压角度为31.8°±7.0°。
带可扩张椎间融合器的BE-TLIF在SL矫正和DH提升方面可能具有优势。这些优势归因于使用了更多前凸的可扩张椎间融合器，结合对侧关节突切除和仔细的终板准备——这是BE-TLIF技术的关键特征。
通过BE-TLIF可以实现SL矫正和DH提升，这有助于减少症状复发并改善腰椎前凸曲线。
