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

Not every patient with painful end-stage degenerative disc disease is a candidate for instrumented fusion surgery or wants it regardless of whether it is carried out through open, mini-open, or minimally invasive incisions. The authors were intrigued by their anecdotal observation that elderly patients with painful vacuum discs serendipitously found during endoscopic decompression went on to successful fusion and enjoyed substantial long-term pain relief. Therefore, we investigated the feasibility of a transforaminal endoscopic decompression and un-instrumented lumbar interbody fusion procedures with cancellous bone allograft. A total of 29 patients had their vacuum discs directly visualized with a modified hybrid transforaminal technique employing procedural components of both the outside-in and the inside-out technique. Intraoperative endoscopic visualization of a painful, hollow collapsed, rigid intervertebral disc space allowed grafting it with cancellous allograft chips. In addition to 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 scores reduced from 7.34 ± 1.63 and 50.03 ± 10.64 preoperatively to 1.62 ± 1.741 and 6.69 ± 4.294 postoperatively (p lt; 0.0001). According to Macnab criteria, excellent and good clinical outcomes were obtained in 34.5% and 62.1% of patients, respectively. Only one patient had minimal improvement from "Poor" preoperatively to "Fair" postoperatively. Computed tomography assessment of interbody fusion at the last follow-up showed successful fusion in 91.4% of patients. Based on these study observations, the authors concluded that an un-instrumented interbody fusion by packing a hollow interspace with cancellous bone allograft chips could be an adjunct to endoscopic foraminal lateral recess decompression select patients with validated painful, collapsed, and rigid motion segments.