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| LI Zhenzhou,CAO Zheng,ZHAO Hongliang.Technical notes and clinical outcomes of full-endoscopic interbody fusion via transforaminal approach for hard disc herniations in thoracolumbar junction[J].Chinese Journal of Spine and Spinal Cord,2024,(4):362-371. |
| Technical notes and clinical outcomes of full-endoscopic interbody fusion via transforaminal approach for hard disc herniations in thoracolumbar junction |
| Received:November 26, 2023 Revised:March 16, 2024 |
| English Keywords:Intervertebral disc herniation Full-endoscopic interbody fusion Discectomy Transforaminal approach |
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| 【Abstract】 Objectives: To study the technical notes and clinical outcomes of full-endoscopic interbody fusion via transforaminal approach for hard disc herniations in thoracolumbar junction. Methods: 14 patients with disc herniations involving 20 segments of hard disc herniations in thoracolumbar junction treated with full-endoscopic interbody fusion via transforaminal approach between January 2018 and September 2021 were included in the study. There were 11 males and 3 females with an average age of 43.3±12.6 years; 3-segment disease in 2 cases, 2-segment disease in 2 cases, and single segment disease in 10 cases. The hard compression were classified as: 3 cases of calcified disc herniation, 6 cases of osteophyte protrusion of the posterior edge of the adjacent vertebral body of the diseased disc, 3 cases of disc herniations with atypical Scheuermann disease and 2 cases of disc herniation with epiphyseal separation. All patients had symptoms of myelopathy or cauda equina compromise before operation, and 6 of them had radiculopathy. Via transforaminal approach under local anesthesia, full-endoscopic interbody fusion and discectomy were performed firstly, followed with percutaneous pedicle screw system placement and fixation under general anesthesia. Postoperative imaging changes, pain symptoms and recovery of neurological function at 1 week, 3 months, 6 months and 1 year after operation were observed. Back pain and radicular pain were scored with visual analogue scale(VAS), neurological function was assessed with Nurick score and modified Japanese Orthopaedic Association(mJOA) score, and thoracic spine function was assessed with Oswestry disability index(ODI). Results: All operations were successfully completed, and no intraoperative conversion of surgical methods occurred. Postoperative thoracolumbar junction MRI and CT examinations of all patients showed that the spinal cord or cauda equina was sufficiently decompressed without any residual compression. At 1 year follow-up, all surgical segments were fused. Back pain and radicular pain were all relieved significantly in all the patients, and neurological function was significantly restored. The Nurick score, mJOA score and ODI all improved compared with the preoperative values(P<0.01), and the postoperative 1 year values all improved significantly compared with the values at postoperative 1 week, 3 months and 6 months(P<0.01). The average recovery rate of mJOA was 72.5%, with 7 cases excellent, 5 cases good and 2 cases fair. Dural tear occurred in 2 cases during operation, but no cerebrospinal fluid leakage and pseudomeningocele occurred during follow-up. No other surgical complications occurred. Conclusions: Full-endoscopic interbody fusion and resection of herniated hard disc via transforaminal approach under local anesthesia followed with percutaneous pedicle screw system fixation under general anesthesia are safe and effective minimally invasive spine surgery for the treatment of hard disc herniation located in the thoracolumbar junction. |
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