RT Journal Article
SR Electronic
T1 Biportal Endoscopic Transforaminal Lumbar Interbody Fusion: How to Improve Fusion Rate?
JF International Journal of Spine Surgery
JO Int J Spine Surg
FD International Society for the Advancement of Spine Surgery
SP 582
OP 588
DO 10.14444/8648
VO 18
IS 5
A1 Park, Hyun-Jin
A1 Shin, John I.
A1 You, Ki-Han
A1 Yang, Jason I.
A1 Kim, Nathan
A1 Kim, Yong H.
A1 Kang, Min-Seok
A1 Park, Sang-Min
YR 2024
UL https://www.ijssurgery.com/content/18/5/582.abstract
AB Background Biportal endoscopic transforaminal lumbar interbody fusion (BE-TLIF) is a minimally invasive surgical technique for treating degenerative lumbar spine conditions. It offers advantages such as reduced soft tissue trauma and lower infection rates, but certain technical aspects may be challenging. The current study aims to identify strategies to enhance the fusion rate in BE-TLIF by addressing these specific challenges.Methods A literature review was conducted on techniques to improve fusion rates in BE-TLIF.Results The review suggests that lateral-based portals supplemented with medial portals allowed for safe insertion of interbody cages with large footprint. Direct visualization of the disc space with a 30° endoscope assisted with better disc space preparation. Facetectomies performed with osteotomes, rather than burrs, ensured maximum retrieval of autologous bone graft. Utilizing bone morphogenetic proteins with sustained release carriers such as hydroxyapatite can be useful to increase fusion rates of BE-TLIF.Conclusions To our knowledge, the current literature is the first comprehensive review of strategies to enhance fusion rates in BE-TLIF. The proposed techniques and biological adjuncts are effective means to address key challenges associated with the procedure, and such strategies would potentially shorten the learning curve and improve clinical outcomes. Further clinical studies are required to validate these findings and establish standardized protocols.Clinical Relevance These findings provide practical solutions to overcome common challenges in BE-TLIF. The suggested techniques would reduce the incidence of pseudarthrosis, improve patient outcomes, and ultimately offer a safer and more reliable option for lumbar interbody fusion patients.Level of Evidence 5.