• World Neurosurg · Jul 2019

    Fully-endoscopic lumbar laminectomy and transforaminal lumbar interbody fusion under local anesthesia/conscious sedation: a case series.

    • Jian Shen.
    • Mohawk Valley Orthopedics, Amsterdam, New York, USA; Center for Spine Regeneration Surgery, New York, New York, USA. Electronic address: james2173@yahoo.com.
    • World Neurosurg. 2019 Jul 1; 127: e745-e750.

    ObjectiveTo evaluate clinical outcomes of a case series of 18 patients who underwent fully endoscopic foraminotomy, laminectomy, and transforaminal lumbar interbody fusion combined with percutaneous screw fixation.MethodsThis was a retrospective case series of a single surgeon. Average age of patients was 66 years (range, 51-82 years). All patients had grade I or grade II spondylolisthesis and severe central canal stenosis. Patients underwent endoscopic transforaminal access through Kambin triangle for foraminotomy, discectomy, endplate preparation, and interbody fusion, which was followed by fully endoscopic unilateral laminectomy and bilateral decompression and percutaneous pedicle screw and connecting rod placement.ResultsAll procedures were successful without conversion to open surgery. Mean operative time was 168 minutes, and average estimated blood loss was 36 mL. Mean length of hospital stay was 1.2 days. There were no intraoperative or postoperative complications. Comparison of preoperative and final clinical metrics demonstrated that average Oswestry Disability Index score improved from 48 ± 14 (range, 37-61) to 13 ± 11 (range, 0-27) (P < 0.001). Average visual analog scale back pain score improved from 8.1 ± 2.0 (range, 6.8-10.0) to 1.8 ± 0.9 (range, 0.0-3.5) (P < 0.001). Oswestry Disability Index and visual analog scale back pain scores at last follow-up showed 73% and 78% improvement, respectively, from the preoperative period. There were no cases of nonunion clinically or radiographically on final follow-up of >12 months.ConclusionsFully endoscopic laminectomy and interbody fusion under conscious sedation is an effective treatment with minimal complications for patients with lumbar spondylolisthesis and severe spinal stenosis.Copyright © 2019. Published by Elsevier Inc.

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