Endoscopic Uninstrumented Transforaminal Lumbar Interbody Fusion with Allograft for Surgical Management of Endstage Degenerative Vacuum Disc Disease

Preview this chapter:

Endoscopic Uninstrumented Transforaminal Lumbar Interbody Fusion with Allograft for Surgical Management of Endstage Degenerative Vacuum Disc Disease, Page 1 of 1

< Previous page | Next page > /docserver/preview/fulltext/9789815051513/chap15-1.gif

Not every patient with painful end-stage degenerative disc disease is acandidate for instrumented fusion surgery or wants it regardless of whether it is carriedout through open, mini-open, or minimally invasive incisions. The authors wereintrigued by their anecdotal observation that elderly patients with painful vacuum discsserendipitously found during endoscopic decompression went on to successful fusionand enjoyed substantial long-term pain relief. Therefore, we investigated the feasibilityof a transforaminal endoscopic decompression and un-instrumented lumbar interbodyfusion procedures with cancellous bone allograft. A total of 29 patients had theirvacuum discs directly visualized with a modified hybrid transforaminal techniqueemploying procedural components of both the outside-in and the inside-out technique.Intraoperative endoscopic visualization of a painful, hollow collapsed, rigidintervertebral disc space allowed grafting it with cancellous allograft chips. In additionto the two-year radiographic assessment of fusion, patients were evaluated with VAS,ODI, and modified MacNab criteria. At the final follow-up, mean VAS and ODI scoresreduced from 7.34 ± 1.63 and 50.03 ± 10.64 preoperatively to 1.62 ± 1.741 and 6.69 ±4.294 postoperatively (p < 0.0001). According to Macnab criteria, excellent and goodclinical outcomes were obtained in 34.5% and 62.1% of patients, respectively. Onlyone patient had minimal improvement from "Poor" preoperatively to "Fair"postoperatively. Computed tomography assessment of interbody fusion at the lastfollow-up showed successful fusion in 91.4% of patients. Based on these studyobservations, the authors concluded that an un-instrumented interbody fusion bypacking a hollow interspace with cancellous bone allograft chips could be an adjunct toendoscopic foraminal lateral recess decompression select patients with validatedpainful, collapsed, and rigid motion segments.