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Full Percutaneous Transforaminal Lumbar Interbody Fusion Using the Facet-sparing, Trans-Kambin Approach

Morgenstern, Christian MD, PhD*; Yue, James J. MD; Morgenstern, Rudolf MD, PhD*

doi: 10.1097/BSD.0000000000000827
Primary Research: PDF Only

Study Design: This was a prospective, multicenter, consecutive case series’ study.

Objective: The objective of this study was to evaluate a novel facet-sparing, percutaneous transforaminal lumbar interbody fusion (pTLIF) technique consisting of percutaneous insertion of an expandable interbody cage through an endoscopic cannula with the trans-Kambin approach and complemented with percutaneous transpedicular screws and rods.

Summary of Background Data: Lumbar interbody fusion by open or minimally invasive surgery is the usual treatment for degenerative disk disease but requires a relatively long recovery period. The transforaminal trans-Kambin approach is a standard in endoscopic spine surgery for safe intradiscal access without facet resection.

Methods: Preoperative and postoperative Visual Analogue Scale (VAS) and Oswestry Disability Index scores were quantitatively assessed at 1, 3, 6, and 12 months after surgery and then every 12 months for patients treated with pTLIF between 2009 and 2018 in 2 health care centers. An immediate postoperative control computed tomography scan was performed, whereas conventional postoperative x-ray controls were performed at 1 month and 1 year. Statistical evaluation was performed with the Student t test.

Results: A total of 51 patients (mean age, 59.3 y) were evaluated. The overall mean VAS score for axial lumbar pain improved from 6.6 to 1.8 (P<0.01), mean VAS score for leg pain from 5.5 to 1.2 (P<0.01), and mean Oswestry Disability Index scores from 30.3 to 11.8 (P<0.01) postoperatively with a mean follow-up of 27.9 months (range, 1–77.8 mo). Median estimated blood loss was 103.6 mL. Postoperative complications included 12 (22%) cases with transitory ipsilateral dysesthesia, 2 (4%) cases with transitory ipsilateral muscle weakness, and 3 (6%) clinically asymptomatic cases with radiologic cage subsidence. Median hospital stay was 1.4 days (range, 1–3.2 d).

Conclusions: Postoperative scores for pTLIF significantly improved with minimal blood loss and no long-term complications. On the basis of this experience, the facet-sparing pTLIF is a reliable and safe technique with early hospital discharge, opening the way to outpatient instrumented spine surgery.

Level of Evidence: Level III.

*Morgenstern Institute of Spine, Teknon Medical Center, Barcelona, Spain

Northeast Alliance Surgery Center, CT Orthopaedic Specialists, Frank H. Netter School of Medicine, Hamden, CT

J.J.Y. is a consultant for Richard Wolf Spine. R.M. reports royalty fees from DePuy/Synthes and Interventional Spine Inc., as well as royalty fees from Joimax GmbH outside of the submitted work. C.M. declares no conflict of interest.

Reprints: Christian Morgenstern, MD, PhD, Morgenstern Institute of Spine, Teknon Medical Center, C/ Vilana 12, 08022 Barcelona, Spain (e-mail:

Received February 24, 2019

Accepted April 19, 2019

© 2019 by Lippincott Williams & Wilkins, Inc.