Methods and Early Clinical Results of Percutaneous Lumbar Interbody Fusion

OBJECTIVE: Percutaneous lumbar interbody fusion (PELIF) is a procedure that includes the use of new devices, which allow minimally invasive diskectomy under the percutaneous full-endoscopic guidance and safe percutaneous insertion of a standard-sized cage. This procedure can be applied to severe disk degeneration, spondylolisthesis, and all lumbar intervertebral levels including the L5–S1 level. We report the methods and the clinical outcomes of this procedure. METHODS: Percutaneous diskectomy was performed with an outer sheath cutter and other devices. A cage was inserted with an L-shaped retract-slider. Hybrid facet screw fixation was performed for severe disk degeneration without spondylolisthesis. Conventional percutaneous pedicle screw fixation was performed for spondylolisthesis. The subjects consisted of 21 patients, who underwent PELIF and were followed up for 1 year or longer. RESULTS: No complications related to cage insertion were detected. The mean visual analogue scale scores were improved from 6.1 to 1.9 for lower back pain in severe disc degeneration cases without spondylolisthesis, and from 7.6 to 1.0 for lower extremity symptoms in spondylolisthesis cases. CONCLUSION: The clinical outcomes were favorable. PELIF was found to be a minimally invasive method that did not compromise safety and efficiency. PELIF is a possible therapeutic option that should be considered for not only spondylolisthesis at various intervertebral levels but also for severe disk degeneration because of its minimal invasiveness.