Introduction: Direct neural decompression cannot be achieved by performing lateral lumbar interbody fusion (LLIF). To overcome the indirect decompressive effect of LLIF, additional endoscopic discectomy with oblique lateral interbody fusion (OLIF) has been attempted. The purpose of this study was to assess the clinical and radiological outcomes of patients who underwent OLIF with additional endoscopic discectomy.

Methods: Spinal endoscopic discectomy-assisted OLIF was attempted to remove herniated disc material. Only patients with a follow-up time that exceeded 6 months were enrolled. Clinical parameters examined were the Oswestry Disability Index and visual analog scale scores of back and leg pain. Postoperative MRI was also performed within 3 days of operation to evaluate the decompression status.

Results: Eighteen patients were enrolled. Central and foraminal disc herniations were evident in 8 and 6 patients, respectively. Four patients had impending cauda equina syndrome due to severe spinal canal compromise. Concomitant central or foraminal herniated discs were removed completely after additional endoscopic discectomy, and disc removal was confirmed by postoperative MRI. Mean preoperative visual analog scale scores and Oswestry Disability Index scores improved postoperatively.

Conclusions: OLIF with additional endoscopic discectomy results in successful direct neural decompression without posterior decompressive procedures. Endoscopic assistance might overcome the limitations of LLIF.

Patient Care: By decreasing of damage on patient's back muscle, facet joints, and ligamentous structures.

Learning Objectives: By the conclusion of this session, participants should be able to know the innovative and minimally invasive lumbar interbody fusion using spinal endoscopy.

References: 1: Heo DH, Kim JS. Clinical and radiological outcomes of spinal endoscopic discectomy-assisted oblique lumbar interbody fusion: preliminary results. Neurosurg Focus. 2017 Aug;43(2):E13. 2: Heo DH, Choi WS, Park CK, Kim JS. Minimally Invasive Oblique Lumbar Interbody Fusion with Spinal Endoscope Assistance: Technical Note. World Neurosurg. 2016 Dec;96:530-536. 3: Kim JS, Seong JH. Endoscope-assisted oblique lumbar interbody fusion for the treatment of cauda equina syndrome: a technical note. Eur Spine J. 2017 Feb;26(2):397-403. 4: Jin J, Ryu KS, Hur JW, Seong JH, Kim JS, Cho HJ. Comparative Study of the Difference of Perioperative Complication and Radiologic Results: MIS-DLIF (Minimally Invasive Direct Lateral Lumbar Interbody Fusion) Versus MIS-OLIF (Minimally Invasive Oblique Lateral Lumbar Interbody Fusion). Clin Spine Surg. 2017 Jan 4. 5: Kim JS, Choi WS, Sung JH. 314 Minimally Invasive Oblique Lateral Interbody Fusion for L4-5: Clinical Outcomes and Perioperative Complications. Neurosurgery. 2016 Aug;63 Suppl 1:190-1.