Biportal Endoscopic Transforaminal Lumbar Interbody Fusion: How to Improve Fusion Rate?

IF 1.7 Q2 SURGERY
Hyun-Jin Park, John I Shin, Ki-Han You, Jason I Yang, Nathan Kim, Yong H Kim, Min-Seok Kang, Sang-Min Park
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引用次数: 0

Abstract

Background: Biportal endoscopic transforaminal lumbar interbody fusion (BE-TLIF) is a minimally invasive surgical technique for treating degenerative lumbar spine conditions. It offers advantages such as reduced soft tissue trauma and lower infection rates, but certain technical aspects may be challenging. The current study aims to identify strategies to enhance the fusion rate in BE-TLIF by addressing these specific challenges.

Methods: A literature review was conducted on techniques to improve fusion rates in BE-TLIF.

Results: The review suggests that lateral-based portals supplemented with medial portals allowed for safe insertion of interbody cages with large footprint. Direct visualization of the disc space with a 30° endoscope assisted with better disc space preparation. Facetectomies performed with osteotomes, rather than burrs, ensured maximum retrieval of autologous bone graft. Utilizing bone morphogenetic proteins with sustained release carriers such as hydroxyapatite can be useful to increase fusion rates of BE-TLIF.

Conclusions: To our knowledge, the current literature is the first comprehensive review of strategies to enhance fusion rates in BE-TLIF. The proposed techniques and biological adjuncts are effective means to address key challenges associated with the procedure, and such strategies would potentially shorten the learning curve and improve clinical outcomes. Further clinical studies are required to validate these findings and establish standardized protocols.

Clinical relevance: These findings provide practical solutions to overcome common challenges in BE-TLIF. The suggested techniques would reduce the incidence of pseudarthrosis, improve patient outcomes, and ultimately offer a safer and more reliable option for lumbar interbody fusion patients.

Level of evidence: 5:

双门内窥镜经椎间孔腰椎椎体间融合术:如何提高融合率?
背景:双门内窥镜经椎间孔腰椎椎体间融合术(BE-TLIF)是一种治疗腰椎退行性病变的微创手术技术。它具有减少软组织创伤和降低感染率等优点,但某些技术方面可能具有挑战性。本研究旨在通过解决这些特定挑战,确定提高 BE-TLIF 融合率的策略:方法:对提高BE-TLIF融合率的技术进行了文献综述:结果:文献综述表明,以外侧为入口,辅以内侧入口,可以安全地插入椎间融合器,且椎间融合器占地面积大。使用 30° 内窥镜直接观察椎间盘间隙有助于更好地准备椎间盘间隙。使用截骨器而非毛刺进行的面骨切除术可确保最大限度地回收自体骨移植。利用羟基磷灰石等缓释载体的骨形态发生蛋白可以提高BE-TLIF的融合率:据我们所知,目前的文献是首次对提高 BE-TLIF 融合率的策略进行全面综述。所提出的技术和生物辅助手段是应对手术相关关键挑战的有效手段,这些策略有可能缩短学习曲线并改善临床结果。还需要进一步的临床研究来验证这些发现并制定标准化方案:这些发现为克服BE-TLIF中的常见挑战提供了切实可行的解决方案。临床相关性:这些发现为克服BE-TLIF中的常见难题提供了切实可行的解决方案,所建议的技术将降低假关节的发生率,改善患者的预后,最终为腰椎椎间融合术患者提供更安全、更可靠的选择:5:
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
3.10
自引率
0.00%
发文量
162
期刊介绍: The International Journal of Spine Surgery is the official scientific journal of ISASS, the International Intradiscal Therapy Society, the Pittsburgh Spine Summit, and the Büttner-Janz Spinefoundation, and is an official partner of the Southern Neurosurgical Society. The goal of the International Journal of Spine Surgery is to promote and disseminate online the most up-to-date scientific and clinical research into innovations in motion preservation and new spinal surgery technology, including basic science, biologics, and tissue engineering. The Journal is dedicated to educating spine surgeons worldwide by reporting on the scientific basis, indications, surgical techniques, complications, outcomes, and follow-up data for promising spinal procedures.
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