2023, Vol. 27 ›› Issue (27): 4401-4407

Endoscopic transforaminal lumbar interbody fusion for degenerative diseases of the lumbar spine: decompression fusion and preservation of posterior spine anatomy

Jin Xinjie, Lu Xiangdong, Zhao Yibo, Zhao Xiaofeng, Qi Detai, Zhao Bin   

Abstract: BACKGROUND: Lumbar degenerative disease is a common disease in middle-aged and elderly patients. Traditional lumbar spine surgery is more traumatic and takes a long time to recover after surgery. In recent years, spinal endoscopic technology has achieved great development, and endoscopic transforaminal lumbar interbody fusion, as a new treatment for lumbar degenerative diseases, is worth promoting in patients with indications for lumbar degenerative diseases because of the advantages of less trauma, shorter recovery time, less postoperative pain, and less bleeding.  
OBJECTIVE: To review the research progress of endoscopic transforaminal lumbar interbody fusion in lumbar degenerative diseases, review the occurrence, development, advantages, limitations, and development trend of endoscopic transforaminal lumbar interbody fusion.
METHODS: The first author used a computer to search PubMed, Web of Science and Wanfang databases for the literature published from 2010 to 2022. Key words were “endoscopic lumbar fusion, lumbar degenerative disease, minimally invasive spine” in Chinese and English. Duplicate, poor quality and irrelevant articles were excluded for review analysis.  
RESULTS AND CONCLUSION: (1) Degenerative diseases of the lumbar spine are the pathological basis of disc herniation, spinal stenosis, and vertebral slippage, and are the main cause of discogenic lower back pain. Endoscopic transforaminal lumbar interbody fusion is a novel technique for the treatment of degenerative diseases of the lumbar spine. (2) In recent years, endoscopic lumbar spine surgery has evolved from simple decompression to simultaneous decompression and fusion, with satisfactory short-term results. Microscopic fusion and flexible anesthesia are the greatest highlights of this technique, which has the advantages of less surgical trauma, less bleeding, shorter hospital stay, less postoperative pain, faster recovery, and preservation of the posterior spinal structures, but because of the need for repeated intraoperative fluoroscopy, the relatively high radiation exposure to the surgeon and the patient, as well as the higher requirements for the surgeon’s operating skills. (3) The use of endoscopic transvertebral foramina for the treatment of degenerative lumbar spine disease is now considered to be a potentially effective novel treatment compared to conventional surgery. In previous studies of endoscopic transforaminal lumbar interbody fusion, there were some shortcomings in the use of large amounts of saline to flush the surgical site intraoperatively causing occult blood loss, and these occult blood losses could not be calculated, which was not included in the relevant literature. Second, because fewer hospitals can perform endoscopic transforaminal lumbar interbody fusion and lack the support of large samples and long-term follow-up evidence, its long-term efficacy still needs further study.

Key words: endoscopic lumbar fusion, lumbar degenerative disease, minimally invasive, review