Percutaneous Transforaminal Lumbar Interbody Stabilization

Chapter 29 Percutaneous Transforaminal Lumbar Interbody Stabilization



Sang-Ho. Lee, MD, PhD, Won-Chul. Choi, MD


Percutaneous endoscopic transforaminal discectomy has been an effective alternative to microdiscectomy for patients with soft lumbar disc herniations [1–5]. However, it is ineffective in the presence of lumbar segmental instability due to degenerative disc disease. Percutaneous transforaminal lumbar interbody stabilization (PTLIS) is a new surgical method for treating lumbar segmental instability due to degenerative disc disease and low-grade degenerative spondylolisthesis.


The specially designed B-Twin expandable holder (Disc-O-Tech Medical Technologies Ltd., Herzliya, Israel), which is made of titanium, is used as an interbody spacer to achieve stability without open discectomy and fusion [6–11]. In cases of failure, this minimally invasive procedure does not impede conventional surgical approaches.



Advantages


The major advantages of PTLIS are as follows:


image It requires a small insertion diameter.

image There is no soft tissue and bone damage.

image The facet joints are not destroyed.

image Stability is not compromised.

image There is no dural sac or root manipulation.

image There is less risk of cerebrospinal fluid fistula and neurologic compromise.

image The amount of bleeding is negligible.

image There is a lower risk of infection.

image The procedure can be done alone or supplemented with pedicle screw fixation.


Indications


PTLIS is performed for the following conditions:


image Degenerative disc disease (DDD)

image Internal disc derangement syndrome (IDD)

image Herniated lumbar discs with segmental instability

image Degenerative spondylolisthesis

image Spinal stenosis with segmental instability

image Recurrent disc herniation


Contraindications


The contraindications to PTLIS include the following:


image Infectious conditions such as tuberculosis

image Severe osteoporosis

image More than grade II spondylolisthesis

image Spine infection, tumor, metabolic bone disease


Complications


The following complications have occurred with PTLIS:


image Deterioration of the spinal curvature

image Implant migration or malpositioning

image Device deformity or breakage

image Infection

image Bone fracture at the level of surgery

image Discitis, arachnoiditis, or other inflammation

image Subsidence


Preoperative preparation



Patient Symptoms


The patient in whom PTLIS is performed suffers from low back pain with or without leg pain due to instability.



Imaging Diagnosis


PTLIS is performed in patients in whom imaging detects the following:


image Magnetic resonance imaging findings correspond with physical findings.

image Computed tomography depicts a soft disc herniation.

Plain films are used preoperatively for intervertebral space measurement.



Instrumentation


The implant is supplied preloaded on its delivery system. It is inserted into the intervertebral space in a narrowed tube configuration and is expanded once in place.


Prior to surgery, the required implant diameter is determined through the use of lateral and anteroposterior radiographs and computed tomography or magnetic resonance imaging. The intervertebral space is measured, and 10% to 20% is added to determine the appropriate expanded diameter of the device (Table 29.1). This diameter determines the implant to be selected.



Table 29.1 Selection of Size of B-Twin Implant*

image

The length of the intervertebral space (the anteroposterior borders of the vertebral body) should be at least 28 mm for the use of the trapezoid implants. Verification of implant diameter and length is also performed during surgery, as detailed in the later Figures 29-1 to 29-8 illustrate the instrumentation for PTLIS.


image

Figure 29–1 Rigid working channel scope (KISS, EKL, UK).

Related posts:

Lateral Interbody Fusion Using the XLIF System Minimally Invasive Percutaneous Lumbar Fusion Technique Sacroiliac Joint Block and Neuroablation Anterior Endoscopic Cervical Microdecompression of Disc and Foramen Outcome Measurements for Minimally Invasive Percutaneous Spine Techniques Spinal Cord Stimulation

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Aug 5, 2016 | Posted by in NEUROSURGERY | Comments Off on Percutaneous Transforaminal Lumbar Interbody Stabilization

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