Full-Endoscopic Decompression Combined with Oblique Lumbar Interbody Fusion for Treating Lumbar Spinal Stenosis with Prolapsed Nucleus Pulposus

Summary

We describe a minimally invasive surgery using a full-endoscopy system to complete the spinal canal decompression visually in oblique lumbar interbody fusion surgery for lumbar spinal stenosis with prolapsed nucleus pulposus.

Abstract

Oblique lumbar interbody fusion (OLIF) has been widely used to treat lumbar spinal stenosis. However, patients with prolapsed nucleus pulposus are not suitable for this surgery. We introduce a hybrid surgical procedure combining OLIF and full-endoscopic spinal canal decompression to address this issue. During the OLIF procedure, after completing the discectomy, the endoscopic system is inserted into the intervertebral space to perform the latter half of the discectomy, remove the loose nucleus pulposus, and achieve direct decompression of the nerve root under visualization. After decompression, the free nerve root can be seen under the endoscopic view. With the assistance of endoscopy, the indications for OLIF surgery can be expanded, allowing for the treatment of cases with sciatica caused by the nucleus pulposus. Intraoperative X-ray fluoroscopy can determine the direction and location of decompression under the endoscopy. All patients experienced satisfactory relief from their lumbar and leg pain after the surgery with no complications. Full-endoscopic decompression combined with oblique lumbar interbody fusion is an effective, safe surgical technique for lumbar spinal stenosis with prolapsed nucleus pulposus.

Introduction

Oblique lumbar interbody fusion (OLIF) has been widely used for the treatment of lumbar spinal stenosis^1,2,3,4. It has many advantages, such as the oblique approach reducing the need for extensive dissection of muscles, ligaments, and nerves, large interbody cages, and extensive bone grafting, leading to higher fusion rates and more durable outcomes^4,5,6. However, due to the technical principle of tightening the ligament to achieve indirect decompre....

Protocol

This study has been approved by the Ethics Committee of Hebei General Hospital. Informed consent has been obtained from all individual participants.

NOTE: A flow diagram of full-endoscopic decompression combined with OLIF surgery is shown in Figure 1.

1. Preoperative preparation (Radiographic study)

1. Determine the surgical segment for the patient according to the physical examination and radiological study.Use the imaging evaluation to locate the herniated disc, determine the height of the intervertebral space, and check whether there is calcification (

Results

From December 2023 to October 2024, this surgery was performed on 8 patients in our hospital, including 5 males and 3 females aged 44-78 years with an average of 67.9 years. The average operation time was 135.8 min.

Patients presented relief of their symptoms including Intermittent claudication and sciatica. The neurological function on each follow-up greatly improved compared with that before surgery.

Discussion

This surgery alleviates symptoms caused by both spinal stenosis and prolapsed nucleus pulposus, resulting in satisfactory clinical outcomes for the patients. The satisfactory clinical outcomes are attributed to the direct decompression of the spinal canal under the endoscopy, which differs from the traditional OLIF surgery where spinal canal decompression relies on the tension of the posterior longitudinal ligament after increasing the intervertebral height^4,6

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Artificial bone	Sichuan Guona Technology Co.,LTD	NNBP/40D	4 mm × 4 mm × 20 mm
Endoscope system	SPINENDOS GmbH	SP081430.030	Inner diameter: 4.3 mm; Outer diameter:7.0 mm; Field angle: 80°; Visual angle: 30°; Working length: 181 mm.
Endoscopic forceps	SPINENDOS GmbH	SP082781.835	Φ2.5 mm × 330 mm
Endoscopic hook	SPINENDOS GmbH	SP082628.351	Φ2.5 mm × 310 mm
High-speed burr	XISHAN	LB29035J.DS	Φ3.5 mm × 310 mm
Interventional radiology	ELLIQUENCE	DTF-40	40 cm
Peek cage	Bonovo	O-FUSE	50 mm × 18 mm ×13 mm
rhBMP-2	Jiuyuan Gene Engineering Co., Ltd	rhBMP-2	1.0 mg
Screws	Ruihe Medical	F0-05	Φ7.0 mm × 45 mm