1. 2019;22;75-88Full-Endoscopic Lumbar Fusion Outcomes in Patients with Minimal Deformities: A Retrospective Study of Data Collected Between 2011 and 2015
   Observational Study
   Paul D. Sampson, PhD, Dawei Lu, MD, Solomon Kamson, MD, PhD, and Yiyi Zhang, BS.

BACKGROUND: Open transforaminal lumbar interbody fusion (TLIF) is the gold standard treatment for back pain due to degenerative disc disease and lumbar instability. Traditional open TLIF has been associated with extensive tissue dissection, excessive blood loss, and slow recovery time. Full-endoscopic transforaminal lumbar interbody fusion (FE-TLIF) is an evolving treatment.

OBJECTIVES: This study aims to review outcomes of FE-TLIF performed in an ambulatory surgery center (ASC) on patients with advanced disc disease with minimal spinal deformity.

STUDY DESIGN: This study employed a retrospective cohort design.

METHODS: This Western Institutional Review Board-approved study (#1-925640-1) assessed blood loss, operative time (OR time), post anesthesia care unit time (PACU time), and Visual Analog Scale (VAS) of 85 patients who underwent FE-TLIF between 2011 and 2015 and were followed up for 12 months. Relationships between risk factors (demographics, clinical presentation) and outcomes were analyzed.

RESULTS: No intraoperative complications were observed. There were 2 cases of postoperative sympathetically mediated pain and 3 reoperations. The number of decompression/fusion levels was crucial to OR time but had a smaller impact on PACU time. OR time for patients with 2-level fusion was 110 minutes longer than for those with one level operation. BMI and age had no significant effect on OR time. BMI had a modest effect on PACU time. Gender and age did not affect PACU time. A significant decrease in VAS was observed.

LIMITATIONS: This study has several limitations, including the lack of a control group and reliance on patient-reported outcomes (VAS). In addition, fusion rate and global sagittal alignment were not measured. Although not statistically significant, the use of facet screws, unilateral, or bilateral pedicle screws presented variation in techniques within the group. Early recovery also diminished the incentive for long-term follow-up.

CONCLUSION: FE-TLIF is a feasible technique for lumbar stabilization surgery in an ASC in select patients. This level-II study demonstrates safety in a variety of clinical presentations, including obesity, extremes of age, and anatomical access challenge. Larger clinical series are necessary to validate this technique, particularly for the treatment of patients with advanced spinal deformities.

KEY WORDS: Full-endoscopic, minimally invasive spine surgery, postoperative complications,TLIF, lumbar fusion, low back pain