J Minim Invasive Spine Surg Tech.  2025 Jan;10(Suppl 1):S58-S66. 10.21182/jmisst.2024.01634.

Minimally Invasive Strategy for Uniportal Full-Endoscopic Transforaminal Lumbar Interbody Fusion Using a Large Cage Utilized in Oblique Lumbar Interbody Fusion

• Ma HJ
• Lee SH
• Park CH

• KMID: 2566282
• DOI: http://doi.org/10.21182/jmisst.2024.01634

Abstract

A spine endoscope can be used for lumbar interbody fusion, and endoscopic spinal surgery has various advantages over conventional open surgery. With just one small incision, uniportal full-endoscopic surgery can be the most minimally invasive approach. This technique can minimize intraoperative tissue damage, but the working space is very narrow, making it challenging to insert a large cage and posing a dilemma for an additional large skin incision. The anterior approach for lumbar interbody fusion, particularly oblique lumbar interbody fusion (OLIF), has advantages, such as a wider fusion bed and a large supportive cage, potentially increasing the fusion rate and reducing the risk of cage subsidence. Furthermore, OLIF cages can provide robust support to the apophyseal ring of the vertebral body. An elliptical skin incision is performed to expand the usable area for inserting a large cage and pedicle screw. We aimed to introduce a minimally invasive technique for inserting a large OLIF cage during uniportal full-endoscopic transforaminal lumbar interbody fusion through a single small incision measuring 1.8–2 cm, which could facilitate minimal tissue damage and maximal fusion rate by combining the advantages of endoscope and anterior fusion surgery.

Keyword

Uniportal full-endoscopic surgery; Endoscopy; Transforaminal lumbar interbody fusion; Oblique