Lumbar percutaneous endoscopic interbody fusion.

Abstract

Since 1982, percutaneous endoscopic control has been found to be a fundamental help for selective posterior subligamentary decompression in lumbar contained disc herniations. After the first clinical experience in 1986 with percutaneous intervertebral bone grafting, the need for sufficient percutaneous preparation of the adjacent vertebral plates and postoperative immobilization of the operated on segment became evident. So in 1988, the original eccentrically abrasive end plate cutter for application under discoscopy was introduced. For a preoperative trial and postoperative stabilization, the complementary use of the external pedicle fixation device was standardized in 1988. The use of percutaneous autologous bone interposition was found essential for optimal bony interbody consolidation. The indications were limited strictly to monosegmental lumbar dysfunctions without a need for peridural decompression. In a series of 37 patients with standardized procedure and a mean followup of 33 months, bony interbody consolidation was achieved in 30 cases. The technique desists from any need for blood transfusion, and functional rehabilitation is facilitated because of the very limited percutaneous approach.