title: Percutaneous endoscopic transforaminal lumbar interbody fusion: is it worth it?
abstract: OBJECTIVE
  Interbody spine fusion with cages was first described by Bagby and has been performed for a long time now in a variety of different conditions. We developed a percutaneous endoscopic lumbar fusion technique based on the principles of Kambin and an original titanium cage.
  
  
  METHODS
  From 2004 to 2010, 57 patients were operated on, 17 patients were male with a mean age of 50.29 years (range 34-71 years) and 40 were female with a mean age of 57.42 years (29-90 years). Nineteen patients had a previous operation. Patients were operated on under local anaesthesia in the prone position under image intensifier and a transforaminal percutaneous endoscopic approach.
  
  
  RESULTS
  Fifty cases had a bilateral cage through a bilateral endoscopic approach, and seven cases had a unilateral endoscopic approach only; of those, three cases had only one cage. Eleven patients had a contemporary posterior plate fixation at the same time of the endoscopic cage fusion. Eight patients had a postoperative radicular pain with paresthesias. Asymptomatic migration of the cages occurred in two cases and symptomatic migration requiring a conventional secondary reoperation in 13 cases after a mean delay of eight months (range three to 36 months). The mean ODI after two years or more was 34.3 % (initial ODI 69.4 %).
  
  
  CONCLUSIONS
  The technique was introduced in our practice to take care of difficult or grave co-morbidity patients, and some patients had excellent lasting results following a very short procedure and hospital stay. However, given the 36 % complication rate in this series, we do not recommend it unless decisive technical improvements are made.
authors: Department of Orthopaedics, Hôpital Saint Antoine, Paris, France. frederic.jacquot@sat.aphp.fr
authors: Frederic
authors: F
authors: Jacquot
authors: Daniel
authors: D
authors: Gastambide
mesh_terms: D000279:Administration, Cutaneous; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local; D004724:Endoscopy / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000379:methods*; D014025:Titanium; D016896:Treatment Outcome
chemical_list: D014025:Titanium
references: Neurosurg Focus. 2010 Mar;28(3):E6
references: 20192666
references: Spine (Phila Pa 1976). 2010 Dec 15;35(26 Suppl):S368-74
references: 21160402
references: Spine (Phila Pa 1976). 2007 Mar 1;32(5):537-43
references: 17334287
references: Clin Orthop Relat Res. 2010 Sep;468(9):2419-29
references: 20521129
references: Eur Spine J. 2013 Mar;22 Suppl 2:S242-53
references: 22836363
references: Neurosurgery. 2007 Apr;60(4 Suppl 2):203-12; discussion 212-3
references: 17415155
references: Spine (Phila Pa 1976). 2012 Aug 15;37(18):1548-57
references: 22426447
references: J Spinal Disord Tech. 2005 Feb;18 Suppl:S1-6
references: 15699793
references: Spine J. 2004 Nov-Dec;4(6):644-9
references: 15541696
references: J Neurosurg Spine. 2011 Sep;15(3):311-9
references: 21599444
references: J Neurosurg Spine. 2013 Jan;18(1):4-12
references: 23101944
references: Spine (Phila Pa 1976). 2011 Jul 15;36(16):E1105-11
references: 21289578
references: J Spinal Disord Tech. 2008 Oct;21(7):459-67
references: 18836355
references: Surg Technol Int. 2006;15:243-56
references: 17029183
references: Orthopedics. 1988 Jun;11(6):931-4
references: 3387340
references: Spine (Phila Pa 1976). 2010 Dec 15;35(26 Suppl):S322-30
references: 21160396
references: Arch Orthop Trauma Surg. 2011 Jun;131(6):791-6
references: 21161663
references: Spine (Phila Pa 1976). 2011 Apr 20;36(9):E618-21
references: 21245782
references: Spine (Phila Pa 1976). 2004 Aug 15;29(16):E326-32
references: 15303041
references: J Am Acad Orthop Surg. 2007 Jun;15(6):321-9
references: 17548881
references: J Bone Joint Surg Am. 2011 Mar 16;93(6):582-96
references: 21411709
references: Neurosurgery. 2010 Dec;67(6):1757-67; discussion 1767
references: 21107207
references: Spine J. 2003 May-Jun;3(3 Suppl):60S-64S
references: 14589219