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Endoscopic anterior to psoas lumbar interbody fusion: indications, techniques, and clinical outcomes

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Abstract

Purpose

The retrospective study aimed to report the surgical technique and clinic-radiological outcomes of endoscopic anterior to psoas interbody lumbar fusion through the retroperitoneal approach with direct and indirect decompression.

Methods

We retrospectively analyzed the results of clinical parameters of patients who underwent endoscopic anterior to psoas interbody lumbar fusion between June 2013 and June 2022. Clinical outcomes were evaluated by the visual analog scale (VAS) and Oswestry Disability Index (ODI) scores. The radiological outcomes were measured and statistically compared in disc height index (DHI), whole lumbar lordosis (WLL), pelvic Incidence (PI), pelvic tilt (PT), Segmental lordosis (SL), the sagittal vertical axis (SVA).

Results

A total of 35 patients were selected for the procedure ranging in age from 51 to 84 years with 17.83 ± 8.85 months follow-up. The mean operation time in lateral position for one level was 162.96 ± 35.76 min (n = 24), and 207.73 ± 66.60 min for two-level fusion. The mean endoscopic time was 32.83 ± 17.71 min per level, with a total estimated blood loss of 230.57 ± 187.22 cc. The mean postoperative VAS back, leg pain score and ODI improved significantly compared to the preoperative values; Radiological data showed significant change in WLL, SL, DHI, PI, PT, and SS; however, there is no significant difference in SVA postoperatively. Subgroup analysis for the radiographic data showed 50 mm length cage has significantly improved for the DHI, SS and SVA compare to 40 mm length cage. The subgroup analysis results showed that hypertensive patients had significantly higher proportion in the incomplete fusion group compare to complete fusion group at one-year follow-up.

Outcomes

The endoscopic anterior to psoas interbody lumbar fusion achieves satisfactory indirect and direct decompression. This convergent technique presents an effective choice for treating lumbar instability associated with disc herniations and foraminal stenosis, thus complementing the indications for oblique lumbar interbody fusion.

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Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request. The data are not publicly available due to privacy and ethical restrictions.

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Funding

This research is supported by a grant from Korea’s Health Technology R&D Project through the Korea Health Industry Development Institute, funded by the Ministry of Health & Welfare, Republic of Korea (Grant No: HC20C0163). The funder had no role in the design of the study or collection, analysis, or interpretation of data or in writing the manuscript.

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Authors and Affiliations

  1. Department of Neurosurgery, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-Gu, Seoul, 06591, Republic of Korea

    Yanting Liu, Chan Woong Park & **-Sung Kim

  2. Smt. SCL General Hospital, Smt NHL Municipal Medical College, Ahmedabad, Gujarat, India

    Sagar Sharma

  3. Department of Orthopedics, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Bangkok, 10330, Thailand

    Vit Kotheeranurak

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  1. Yanting Liu
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  2. Chan Woong Park
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  5. **-Sung Kim
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Contributions

YT Liu and CW Park are all the Co-first authors with the same contribution to this research.

Corresponding author

Correspondence to **-Sung Kim.

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Conflict interest

The corresponding author, **-Sung Kim, is a consultant of Richard Wolf, GmbH, and Elliquence, LLC. The other authors have no conflicts of interest to declare.

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IRB approval was obtained from Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.

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Liu, Y., Park, C.W., Sharma, S. et al. Endoscopic anterior to psoas lumbar interbody fusion: indications, techniques, and clinical outcomes. Eur Spine J 32, 2776–2795 (2023). https://doi.org/10.1007/s00586-023-07700-w

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