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  • Minimally Invasive External Transforaminal Lumbar Interbody Fusion with minimal bone resection of the facet joint

    Final Number:

    Miguel E Berbeo MD, MSc; Roberto C. Diaz MD; Juan C. Acevedo MD; Oscar Zorro MD; OSCAR HERNANDO FEO - LEE MD; Rafael Uribe MD; Luis F. Martínez MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: Description of the surgical technique and a prospective case series 18 months follow-up study.

    Methods: From July 2008 to April 2011, 67 patients were treated with lumbar spinal fusion using the minimally invasive External Transforaminal Lumbar Interbody Fusion Technique, with posterior pedicular screw fixation supplementation. Diagnoses included degenerative disc disease, degenerative spondylolisthesis and facet cysts. 3 cm paramedian incisions, 5 cms from the midline where used. Using fluoroscopic guidance, a non – traumatic dissection was used to separate de lumbar musculature and through the use of tubular and self-fixating separators, the corresponding facet joint was exposed; a selective inferior facet osteotomy was performed. The medial border of the medial intertransverse muscle was laterally dissected along with the intertransverse membrane, in that way protecting the dorsal root ganglion and the exiting root. Using this technique, we gained access to the Kambin´s safety triangle with sufficient space to perform the discectomy and placement of the intervertebral cage. In all cases, the manipulation of the exiting nerve root was minimal and there was no need to visualize the traversing root. All cases were supplemented by using pedicular screw fixations by way of minimally invasive techniques. Clinical evaluation was performed by using the Oswestry Disability Index and the Visual Analog Scale before surgery and one and six months after the procedure. Patient satisfaction was measured by using the Odom Scale.

    Results: Over 90% of patients showed an improvement in the evaluated parameters after their first post-operative month. The improvement rates remained close to 95% at six, twelve, and eighteen months. There were no major complications or serious neurologic injuries. The average surgical time was less than that reported for the traditional minimally invasive TLIF, and in hospital stay was less than 24 hours in all cases.

    Conclusions: The minimally invasive ETLIF technique allows us to perform a safe and effective interbody fusion, with minimal and less bone removal, low morbidity, and short in – hospital stay and similar clinical outcomes when compared to the conventional minimally invasive TLIF technique

    Patient Care: Our results shows significant decrease in surgical time, bleeding, and morbidity when it compares with traditional TLIF

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the utility of minimally invasive surgical technique in the transforaminal modified approach to lumbar interbody fusion


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