2024 Volume 15 Issue 8 Pages 1100-1106
Background: Percutaneous endoscopic transforaminal lumbar interbody fusion (PETLIF) is an indirect decompression in which an interbody cage that elevates the disc height is inserted through Kambin's triangle with the supplemental fixation using percutaneous pedicle screws. We applied PETLIF as a revision for spinal canal restenosis and foraminal stenosis at the disc level with a history of surgery.
Methods: Eighteen patients who underwent PETLIF for revision were examined. Data on surgical time, perioperative complications, and reoperation rate were reviewed from the medical records. Clinical evaluations were completed in 17 patients using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and numeric rating scale (NRS) for low back pain, lower limb pain, and lower limb numbness obtained at baseline and during a follow-up.
Results: The mean operative time was 82 minutes, and the mean intraoperative blood loss was 16 grams. No complications, including dural tear, postoperative transient dysesthesia, symptomatic postoperative epidural hematoma were observed. Additionally, no cases required additional revisions.
There were 6 patients (5 males and 1 female, average 63.3 years old at surgery) of spinal restenosis, and 11 patients (5 males and 6 females, average 68 years old at surgery) of foraminal stenosis. In spinal restenosis patients, the follow-up period was 5.7±3.7 months, and JOABPEQ showed significant improvement during the follow-up period in low back pain and walking ability, and NRS showed significant improvement in low back and leg pain. In foraminal stenosis patients, the follow-up period was 15.8±10.7 months, JOABPEQ significantly improved during the follow-up period in low back pain, lumbar function, and walking ability, and NRS significantly improved in low back pain, lower extremity pain, and numbness.
Conclusion: Successful clinical results were obtained with few complications and improvements in the domains of JOABPEQ and NRS. Indirect decompression using PETLIF for lumbar spinal restenosis and foraminal stenosis was confirmed as a minimally invasive and safe surgical option of revision.
