Analysis of technical advantages and disadvantages of percutaneous endoscopic lumbar interbody fusion and its trend prospect_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Bin ^1,2 ,  KONG Qingquan ¹ ,  RONG Limin ³

1. Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China;
2. Department of Orthopedics, Hospital of Chengdu Office of People’s Government of Tibetan Autonomous Region, Chengdu Sichuan, 610041, P. R. China;
3. Department of Spine Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou Guangdong, 510630, P. R. China;

Corresponding author：

KONG Qingquan, Email: kongspine@126.com; RONG Limin, Email: ronglimin@21cn.com

Keywords：

Percutaneous endoscopy; lumbar interbody fusion; minimally invasive technology

DOI：

10.7507/1002-1892.202202075

Video：

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Objective To review and evaluate the technical advantages and disadvantages and research progress of percutaneous endoscopic lumbar interbody fusion. Methods The domestic and foreign related research literature on percutaneous endoscopic lumbar interbody fusion was extensively consulted. The advantages, disadvantages, and effectiveness were summarized. And the development trend of this technology was prospected. Results Compared with minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF), percutaneous endoscopic lumbar interbody fusion has less intraoperative and postoperative bleeding, better improvement of low back pain in the early stage after operation, and similar long-term effectiveness, fusion rate, and incidence of complication, but a longer learning curve. The operation time of biportal and large-channel uniportal endoscopic lumbar fusion is close to that of MIS-TLIF, but the operation time of small-channel uniportal endoscopic fusion is longer than that of MIS-TLIF. Conclusion Percutaneous endoscopic lumbar interbody fusion has the advantages of less trauma and good effectiveness, but its learning curve is long, and indications should be strictly selected for this operation. In the future, with the continuous development and complementation of various endoscopic fusion technologies, this technology will gain better application prospects.

Citation： ZHANG Bin, KONG Qingquan, RONG Limin. Analysis of technical advantages and disadvantages of percutaneous endoscopic lumbar interbody fusion and its trend prospect. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(6): 653-659. doi: 10.7507/1002-1892.202202075 Copy

1.	Ruetten S. Full-endoscopic operations of the spine in disk herniations and spinal stenosis. Surg Technol Int, 2011, 21: 284-298.
2.	Ruetten S, Komp M, Merk H, et al. Use of newly developed instruments and endoscopes: full-endoscopic resection of lumbar disc herniations via the interlaminar and lateral transforaminal approach. J Neurosurg Spine, 2007, 6(6): 521-530.
3.	张斌, 孔清泉, 杨进, 等. 经皮内镜下经椎间孔入路双侧减压治疗重度腰椎中央管狭窄症近期疗效. 中国修复重建外科杂志, 2019, 33(11): 1399-1405.
4.	Peng CW, Yue WM, Poh SY, et al. Clinical and radiological outcomes of minimally invasive versus open transforaminal lumbar interbody fusion. Spine (Phila Pa 1976), 2009, 34(13): 1385-1389.
5.	Morgenstern R, Morgenstern C. Percutaneous transforaminal lumbar interbody fusion (pTLIF) with a posterolateral approach for the treatment of denegerative disk disease: feasibility and preliminary results. Int J Spine Surg, 2015, 9: 41. doi: 10.14444/2041.
6.	Wang MY, Grossman J. Endoscopic minimally invasive transforaminal interbody fusion without general anesthesia: initial clinical experience with 1-year follow-up. Neurosurg Focus, 2016, 40(2): E13. doi: 10.3171/2015.11.FOCUS15435.
7.	Youn MS, Shin JK, Goh TS, et al. Full endoscopic lumbar interbody fusion (FELIF): technical note. Eur Spine J, 2018, 27(8): 1949-1955.
8.	Kim JE, Yoo HS, Choi DJ, et al. Comparison of minimal invasive versus biportal endoscopic transforaminal lumbar interbody fusion for single-level lumbar disease. Clin Spine Surg, 2021, 34(2): E64-E71.
9.	Heo DH, Son SK, Eum JH, et al. Fully endoscopic lumbar interbody fusion using a percutaneous unilateral biportal endoscopic technique: technical note and preliminary clinical results. Neurosurg Focus, 2017, 43(2): E8. doi: 10.3171/2017.5.FOCUS17146.
10.	Heo DH, Kim JS. Clinical and radiological outcomes of spinal endoscopic discectomy-assisted oblique lumbar interbody fusion: preliminary results. Neurosurg Focus, 2017, 43(2): E13. doi: 10.3171/2017.5.FOCUS17196.
11.	Kolcun JPG, Brusko GD, Basil GW, et al. Endoscopic transforaminal lumbar interbody fusion without general anesthesia: operative and clinical outcomes in 100 consecutive patients with a minimum 1-year follow-up. Neurosurg Focus, 2019, 46(4): E14. doi: 10.3171/2018.12.FOCUS18701.
12.	Osman SG. Endoscopic transforaminal decompression, interbody fusion, and percutaneous pedicle screw implantation of the lumbar spine: A case series report. Int J Spine Surg, 2012, 6: 157-166.
13.	刘俊麟, 孔清泉. 全脊柱内镜在骨化类继发性腰椎管狭窄症应用中的相关问题述评. 中国骨与关节杂志, 2019, 8(2): 81-87.
14.	Shen J. Fully endoscopic lumbar laminectomy and transforaminal lumbar interbody fusion under local anesthesia with conscious sedation: A case series. World Neurosurg, 2019, 127: e745-e750.
15.	Zhu L, Cai T, Shan Y, et al. Comparison of clinical outcomes and complications between percutaneous endoscopic and minimally invasive transforaminal lumbar interbody fusion for degenerative lumbar disease: A systematic review and meta-analysis. Pain Physician, 2021, 24(6): 441-452.
16.	Ao S, Zheng W, Wu J, et al. Comparison of preliminary clinical outcomes between percutaneous endoscopic and minimally invasive transforaminal lumbar interbody fusion for lumbar degenerative diseases in a tertiary hospital: Is percutaneous endoscopic procedure superior to MIS-TLIF? A prospective cohort study. Int J Surg, 2020, 76: 136-143.
17.	Jacquot F, Gastambide D. Percutaneous endoscopic transforaminal lumbar interbody fusion: is it worth it? Int Orthop, 2013, 37(8): 1507-1510.
18.	Kim JE, Choi DJ. Biportal endoscopic transforaminal lumbar interbody fusion with arthroscopy. Clin Orthop Surg, 2018, 10(2): 248-252.
19.	Kang MS, You KH, Choi JY, et al. Minimally invasive transforaminal lumbar interbody fusion using the biportal endoscopic techniques versus microscopic tubular technique. Spine J, 2021, 21(12): 2066-2077.
20.	Wu PH, Kim HS, Lee YJ, et al. Uniportal full endoscopic posterolateral transforaminal lumbar interbody fusion with endoscopic disc drilling preparation technique for symptomatic foraminal stenosis secondary to severe collapsed disc space: A clinical and computer tomographic study with technical note. Brain Sci, 2020, 10(6): 373. doi: 10.3390/brainsci10060373.
21.	Nagahama K, Ito M, Abe Y, et al. Early clinical results of percutaneous endoscopic transforaminal lumbar interbody fusion: A new modified technique for treating degenerative lumbar spondylolisthesis. Spine Surg Relat Res, 2018, 3(4): 327-334.
22.	Jin M, Zhang J, Shao H, et al. Percutaneous transforaminal endoscopic lumbar interbody fusion for degenerative lumbar diseases: A consecutive case series with mean 2-year follow-up. Pain Physician, 2020, 23(2): 165-174.
23.	Butler AJ, Brusko GD, Wang MY. Awake endoscopic transforaminal lumbar interbody fusion: A technical note. HSS J, 2020, 16(2): 200-204.
24.	Nakamura S, Ito F, Ito Z, et al. Methods and early clinical results of percutaneous lumbar interbody fusion. Neurospine, 2020, 17(4): 910-920.
25.	Zhao XB, Ma HJ, Geng B, et al. Early clinical evaluation of percutaneous full-endoscopic transforaminal lumbar interbody fusion with pedicle screw insertion for treating degenerative lumbar spinal stenosis. Orthop Surg, 2021, 13(1): 328-337.
26.	Heo DH, Lee DC, Kim HS, et al. Clinical results and complications of endoscopic lumbar interbody fusion for lumbar degenerative disease: a meta-analysis. World Neurosurg, 2021, 145: 396-404.
27.	Wu J, Liu H, Ao S, et al. Percutaneous endoscopic lumbar interbody fusion: technical note and preliminary clinical experience with 2-year follow-up. Biomed Res Int, 2018, 2018: 5806037. doi: 10.1155/2018/5806037.
28.	Yang J, Liu C, Hai Y, et al. Percutaneous endoscopic transforaminal lumbar interbody fusion for the treatment of lumbar spinal stenosis: preliminary report of seven cases with 12-month follow-up. Biomed Res Int, 2019, 2019: 3091459.
29.	Leu HF, Hauser RK, Schreiber A. Lumbar percutaneous endoscopic interbody fusion. Clin Orthop Relat Res, 1997, (337): 58-63.
30.	Seaman S, Kerezoudis P, Bydon M, et al. Titanium vs. polyetheretherketone (PEEK) interbody fusion:Meta-analysis and review of the literature. J Clin Neurosci, 2017, 44: 23-29.
31.	孟海, 杨雍, 孙天胜, 等. 腰椎后路手术椎间融合器应用的专家共识. 中国脊柱脊髓杂志, 2021, 31(4): 379-384.
32.	Virk S, Qureshi S. Navigation in minimally invasive spine surgery. J Spine Surg, 2019, 5(Suppl 1): S25-S30.
33.	Dusad T, Kundnani V, Dutta S, et al. Comparative prospective study reporting intraoperative parameters, pedicle screw perforation, and radiation exposure in navigation-guided versus non-navigated fluoroscopy-assisted minimal invasive transforaminal lumbar interbody fusion. Asian Spine J, 2018, 12(2): 309-316.
34.	Quillo-Olvera J, Quillo-Reséndiz J, Quillo-Olvera D, et al. Ten-step biportal endoscopic transforaminal lumbar interbody fusion under computed tomography-based intraoperative navigation: technical report and preliminary outcomes in Mexico. Oper Neurosurg (Hagerstown), 2020, 19(5): 608-618.
35.	Xie P, Feng F, Cao J, et al. Real-time ultrasonography-magnetic resonance image fusion navigation for percutaneous transforaminal endoscopic discectomy. J Neurosurg Spine, 2020, 33(2): 192-198.

1. Ruetten S. Full-endoscopic operations of the spine in disk herniations and spinal stenosis. Surg Technol Int, 2011, 21: 284-298.
2. Ruetten S, Komp M, Merk H, et al. Use of newly developed instruments and endoscopes: full-endoscopic resection of lumbar disc herniations via the interlaminar and lateral transforaminal approach. J Neurosurg Spine, 2007, 6(6): 521-530.
3. 张斌, 孔清泉, 杨进, 等. 经皮内镜下经椎间孔入路双侧减压治疗重度腰椎中央管狭窄症近期疗效. 中国修复重建外科杂志, 2019, 33(11): 1399-1405.
4. Peng CW, Yue WM, Poh SY, et al. Clinical and radiological outcomes of minimally invasive versus open transforaminal lumbar interbody fusion. Spine (Phila Pa 1976), 2009, 34(13): 1385-1389.
5. Morgenstern R, Morgenstern C. Percutaneous transforaminal lumbar interbody fusion (pTLIF) with a posterolateral approach for the treatment of denegerative disk disease: feasibility and preliminary results. Int J Spine Surg, 2015, 9: 41. doi: 10.14444/2041.
6. Wang MY, Grossman J. Endoscopic minimally invasive transforaminal interbody fusion without general anesthesia: initial clinical experience with 1-year follow-up. Neurosurg Focus, 2016, 40(2): E13. doi: 10.3171/2015.11.FOCUS15435.
7. Youn MS, Shin JK, Goh TS, et al. Full endoscopic lumbar interbody fusion (FELIF): technical note. Eur Spine J, 2018, 27(8): 1949-1955.
8. Kim JE, Yoo HS, Choi DJ, et al. Comparison of minimal invasive versus biportal endoscopic transforaminal lumbar interbody fusion for single-level lumbar disease. Clin Spine Surg, 2021, 34(2): E64-E71.
9. Heo DH, Son SK, Eum JH, et al. Fully endoscopic lumbar interbody fusion using a percutaneous unilateral biportal endoscopic technique: technical note and preliminary clinical results. Neurosurg Focus, 2017, 43(2): E8. doi: 10.3171/2017.5.FOCUS17146.
10. Heo DH, Kim JS. Clinical and radiological outcomes of spinal endoscopic discectomy-assisted oblique lumbar interbody fusion: preliminary results. Neurosurg Focus, 2017, 43(2): E13. doi: 10.3171/2017.5.FOCUS17196.
11. Kolcun JPG, Brusko GD, Basil GW, et al. Endoscopic transforaminal lumbar interbody fusion without general anesthesia: operative and clinical outcomes in 100 consecutive patients with a minimum 1-year follow-up. Neurosurg Focus, 2019, 46(4): E14. doi: 10.3171/2018.12.FOCUS18701.
12. Osman SG. Endoscopic transforaminal decompression, interbody fusion, and percutaneous pedicle screw implantation of the lumbar spine: A case series report. Int J Spine Surg, 2012, 6: 157-166.
13. 刘俊麟, 孔清泉. 全脊柱内镜在骨化类继发性腰椎管狭窄症应用中的相关问题述评. 中国骨与关节杂志, 2019, 8(2): 81-87.
14. Shen J. Fully endoscopic lumbar laminectomy and transforaminal lumbar interbody fusion under local anesthesia with conscious sedation: A case series. World Neurosurg, 2019, 127: e745-e750.
15. Zhu L, Cai T, Shan Y, et al. Comparison of clinical outcomes and complications between percutaneous endoscopic and minimally invasive transforaminal lumbar interbody fusion for degenerative lumbar disease: A systematic review and meta-analysis. Pain Physician, 2021, 24(6): 441-452.
16. Ao S, Zheng W, Wu J, et al. Comparison of preliminary clinical outcomes between percutaneous endoscopic and minimally invasive transforaminal lumbar interbody fusion for lumbar degenerative diseases in a tertiary hospital: Is percutaneous endoscopic procedure superior to MIS-TLIF? A prospective cohort study. Int J Surg, 2020, 76: 136-143.
17. Jacquot F, Gastambide D. Percutaneous endoscopic transforaminal lumbar interbody fusion: is it worth it? Int Orthop, 2013, 37(8): 1507-1510.
18. Kim JE, Choi DJ. Biportal endoscopic transforaminal lumbar interbody fusion with arthroscopy. Clin Orthop Surg, 2018, 10(2): 248-252.
19. Kang MS, You KH, Choi JY, et al. Minimally invasive transforaminal lumbar interbody fusion using the biportal endoscopic techniques versus microscopic tubular technique. Spine J, 2021, 21(12): 2066-2077.
20. Wu PH, Kim HS, Lee YJ, et al. Uniportal full endoscopic posterolateral transforaminal lumbar interbody fusion with endoscopic disc drilling preparation technique for symptomatic foraminal stenosis secondary to severe collapsed disc space: A clinical and computer tomographic study with technical note. Brain Sci, 2020, 10(6): 373. doi: 10.3390/brainsci10060373.
21. Nagahama K, Ito M, Abe Y, et al. Early clinical results of percutaneous endoscopic transforaminal lumbar interbody fusion: A new modified technique for treating degenerative lumbar spondylolisthesis. Spine Surg Relat Res, 2018, 3(4): 327-334.
22. Jin M, Zhang J, Shao H, et al. Percutaneous transforaminal endoscopic lumbar interbody fusion for degenerative lumbar diseases: A consecutive case series with mean 2-year follow-up. Pain Physician, 2020, 23(2): 165-174.
23. Butler AJ, Brusko GD, Wang MY. Awake endoscopic transforaminal lumbar interbody fusion: A technical note. HSS J, 2020, 16(2): 200-204.
24. Nakamura S, Ito F, Ito Z, et al. Methods and early clinical results of percutaneous lumbar interbody fusion. Neurospine, 2020, 17(4): 910-920.
25. Zhao XB, Ma HJ, Geng B, et al. Early clinical evaluation of percutaneous full-endoscopic transforaminal lumbar interbody fusion with pedicle screw insertion for treating degenerative lumbar spinal stenosis. Orthop Surg, 2021, 13(1): 328-337.
26. Heo DH, Lee DC, Kim HS, et al. Clinical results and complications of endoscopic lumbar interbody fusion for lumbar degenerative disease: a meta-analysis. World Neurosurg, 2021, 145: 396-404.
27. Wu J, Liu H, Ao S, et al. Percutaneous endoscopic lumbar interbody fusion: technical note and preliminary clinical experience with 2-year follow-up. Biomed Res Int, 2018, 2018: 5806037. doi: 10.1155/2018/5806037.
28. Yang J, Liu C, Hai Y, et al. Percutaneous endoscopic transforaminal lumbar interbody fusion for the treatment of lumbar spinal stenosis: preliminary report of seven cases with 12-month follow-up. Biomed Res Int, 2019, 2019: 3091459.
29. Leu HF, Hauser RK, Schreiber A. Lumbar percutaneous endoscopic interbody fusion. Clin Orthop Relat Res, 1997, (337): 58-63.
30. Seaman S, Kerezoudis P, Bydon M, et al. Titanium vs. polyetheretherketone (PEEK) interbody fusion:Meta-analysis and review of the literature. J Clin Neurosci, 2017, 44: 23-29.
31. 孟海, 杨雍, 孙天胜, 等. 腰椎后路手术椎间融合器应用的专家共识. 中国脊柱脊髓杂志, 2021, 31(4): 379-384.
32. Virk S, Qureshi S. Navigation in minimally invasive spine surgery. J Spine Surg, 2019, 5(Suppl 1): S25-S30.
33. Dusad T, Kundnani V, Dutta S, et al. Comparative prospective study reporting intraoperative parameters, pedicle screw perforation, and radiation exposure in navigation-guided versus non-navigated fluoroscopy-assisted minimal invasive transforaminal lumbar interbody fusion. Asian Spine J, 2018, 12(2): 309-316.
34. Quillo-Olvera J, Quillo-Reséndiz J, Quillo-Olvera D, et al. Ten-step biportal endoscopic transforaminal lumbar interbody fusion under computed tomography-based intraoperative navigation: technical report and preliminary outcomes in Mexico. Oper Neurosurg (Hagerstown), 2020, 19(5): 608-618.
35. Xie P, Feng F, Cao J, et al. Real-time ultrasonography-magnetic resonance image fusion navigation for percutaneous transforaminal endoscopic discectomy. J Neurosurg Spine, 2020, 33(2): 192-198.

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