J Minim Invasive Spine Surg Tech.  2018 Dec;3(2):87-91. 10.21182/jmisst.2018.00381.

Endoscope-assisted Oblique Lumbar Interbody Fusion L5-S1 with Posterior Fixation with Cortical Bone Trajectory Screw Plus Pedicle Screw for Treatment of Adjacent Segment Degeneration Disease: A Technical Note

• Mahatthanatrakul A
• Kotheeranurak V
• Lin GX
• Chung HJ
• Kim JS

• KMID: 2562045
• DOI: http://doi.org/10.21182/jmisst.2018.00381

Abstract

Adjacent segment disease (ASDis) is a common sequela after lumbar spinal fusion. Current surgical treatment for ASDis with instability is decompression and extended fusion which could be done by posterior, lateral or anterior approach. Oblique lumbar interbody fusion (OLIF) could achieve indirect decompression of neural element. But OLIF has a limitation to directly decompress spinal canal in case of a concurrent herniated disc. Spinal endoscopy could enhance the visual field and facilitate herniated disc removal in case of ASDis with migrated lumbar disc herniation. Double trajectory of cortical bone trajectory (CBT) screw and pedicle screw in the same pedicle can be done to avoid the necessity to remove the previous instruments. Intra-operative computed tomography (CT) navigation can guide cortical bone screw when only narrow corridors are left due to the pedicle screws. This study will demonstrate a technical note for ASDis with a concurrent migrated disc herniation at L5-S1 level by combining endoscopic discectomy-assisted OLIF L5-S1 to direct and indirectly decompress neural element with intraoperative CT guided double trajectory CBT screw insertion in lateral decubitus position to avoid the necessity of previous instrument removal and decreased operative time.

Keyword

Endoscopes; Oblique lumbar interbody fusion; Cortical bone trajectory screw; Double trajectory screw; Intraoperative CT navigation; Adjacent segment disease