Endoscopic transforaminal lumbar decompression, interbody fusion and pedicle screw fixation-a report of 42 cases.
OBJECTIVE
To evaluate the surgical procedure of endoscopic transforminal discectomy, bone grafting and Dynalok pedicle screw fixation under X-Tube operation system in the treatment of lumbar disc herniation combined with segmental instability and/or pars defected spondylolithesis.


METHODS
From June 2004 to May 2006, 42 patients with classic features of lumbar disc herniation combined with segmental instability and/or pars defected spondylolithesis underwent endoscopic transforminal lumbar interbody fusion (TLIF). Under the guidance of fluoroscopy, a 2.8 to 3.0 cm incision with 4.5 to 5.0 cm apart from the posterior middle line was made on the symptomatic side and the working portal (X-Tube) was docked unilaterally on the facet joint. A total facetectomy was then performed to expose neural foramina and nerve root. Discectomy and endplate preparation were completed through the tube. A Telamon cage was placed obliquely into the intervertebral space after interbody grafting, and then the Dynalok pedicle screw fixation system was performed. This procedure was accomplished on the lateral side when it is necessary.


RESULTS
Clinical outcomes were determined using the Oswestry Disability Index (ODI) which revealed that 62.2% of patients got excellent results, 29.2% good and 8.6% fair. The average hospital stay was 12.5 days (5-25 days). Operation time averaged 240 min (110-320 min), blood loss averaged 140 ml (80-420 ml) and incision length averaged 3 cm (2.8-3.2 cm). Five patients had complications including wound infection in 1 case, incision dehiscence and focal skin necrosis in 1, progressive radicular pain of contralateral leg in 1 and residual radicular numbness after transient radicular pain in 2.


CONCLUSIONS
This surgical procedure of endoscopic transforminal diskectomy, bone grafting, cage placement and pedicle screw fixation can be effectively accomplished under X-Tube operation system with predominant benefits such as small incision, less stripping of paraspinal muscles, minimal blood loss and rapid postoperative recovery.
Zhou
Yue
Y
Department of Orthopedics, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China. happyzhou@vip163.com
Zhang
Chao
C
Wang
Jian
J
Chu
Tong-wei
TW
Li
Chang-qing
CQ
Zhang
Zheng-feng
ZF
Zheng
Wen-jie
WJ
D000328:Adult; D000368:Aged; D001863:Bone Screws; D019299:Decompression, Surgical / Q000009:adverse effects / Q000379:methods*; D004724:Endoscopy; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods*; D013126:Spinal Nerve Roots / Q000293:injuries