J Minim Invasive Spine Surg Tech.  2025 Jan;10(Suppl 1):S67-S74. 10.21182/jmisst.2024.01697.

Full-Endoscopic Lumbar Interbody Fusion Using the Modified Transfacet Approach: A Novel Technique to Reduce the Risk of Inadvertent Neurovascular Injury

• Asawasaksakul A
• Suebsing A
• Trathitephun W
• Kim JS
• Suvithayasiri S

• KMID: 2566283
• DOI: http://doi.org/10.21182/jmisst.2024.01697

Abstract

This study evaluated the feasibility and safety of a novel "transfacet" technique in full-endoscopic lumbar interbody fusion (FE-LIF) aimed at reducing neurovascular risks through improved visualization and preservation of the medial facet joint walls during cage insertion. A technical note on a degenerative lumbar spinal disease patient who underwent transfacet FE-LIF using this technique is presented. This approach starts at the most dorsal part of the facet joint and employs specialized instruments, including the Harrison Cage Glider (Harrison Spinartus Hospital, Chungdam). The technique was applied to a 61-year-old man with 5 months of low back pain and right leg numbness. Postsurgery, pain was significantly reduced (visual analogue scale score: 2–3), with immediate mobility improvements. Twelve months of follow-up indicated complete symptom resolution without complications. The instruments used included a full-endoscopic system, a polyether-ether-ketone cage, autologous bone grafts, and demineralized bone matrix. The transfacet FE-LIF method demonstrates potential as a feasible and safer alternative for endoscopic spinal fusion, notably during the critical phase of cage insertion. It effectively minimizes risk to nearby neurovascular structures. Comparative studies of emerging endoscopic fusion techniques are required to validate and establish the reproducibility of this proposed method.

Keyword

Lumbar fusion; Full-endoscopic spine surgery; Uniportal endoscopy; Transfacet approach; Minimally invasive surgery; Complication avoidance