A Novel Technique of Endoscopic Transforaminal Lumbar Intervertebral Fusion and Percutaneous Dorsal Spondylodesis in Degenerative Lumbar Spinal Disorders: an Analysis of 70 Patients

Abstract

Background: Degenerative lumbar spinal disorders are a leading cause of chronic pain and disability, significantly impacting patients' quality of life. Traditional open surgical techniques, while effective in stabilizing the spine and relieving pain, are associated with considerable tissue trauma, blood loss, and extended recovery times. These challenges are particularly pronounced in elderly patients with multiple comorbidities. In recent years, minimally invasive techniques such as percutaneous dorsal spinal stabilization (pDSS) and endoscopic transforaminal lumbar intervertebral fusion (eTLIF) have been developed to address these issues. However, the combined use of pDSS and eTLIF in treating degenerative lumbar disorders has not been extensively studied, necessitating further research. Methods: This retrospective study analysed data from 70 patients with degenerative lumbar spinal disorders who underwent a combined pDSS and eTLIF procedure between 2020 and 2022. The patient cohort had a mean age of 71.1 years, and surgeries were performed at various lumbar levels, with L4/5 being the most commonly treated. Key outcomes measured included surgery duration, intraoperative blood loss, length of hospital stay, postoperative pain reduction, and complication rates. Pain levels were assessed using the Numerical Rating Scale (NRS) preoperatively, on the third postoperative day, and at one-year follow-up. Results: The combined pDSS and eTLIF technique demonstrated significant clinical benefits. The average surgery duration was 172.1 minutes, and the mean hospital stay was 8.7 days, both within acceptable ranges for minimally invasive procedures. Intraoperative blood loss was minimal, with all cases recording less than 200cc, highlighting the reduced surgical trauma associated with this approach. Postoperative pain scores showed a marked reduction from a preoperative mean NRS of 3.6 to 1.6 on the third postoperative day, with sustained pain relief observed at one-year follow-up (mean NRS 1.86). Complications were infrequent, with dural tear and cerebrospinal fluid (CSF) leakage being the most common, occurring in 11 patients (15.7%). All dural tears were successfully managed intraoperatively without the need for additional interventions. Conclusions: The combined pDSS and eTLIF technique offers a promising alternative to traditional open spinal surgeries, particularly for elderly patients or those with multiple comorbidities. The procedure effectively reduces intraoperative blood loss, minimizes postoperative pain, and shortens hospital stays, all while maintaining a low complication rate. These findings suggest that the combined use of pDSS and eTLIF could enhance patient outcomes in the treatment of degenerative lumbar spinal disorders. However, further studies with larger sample sizes and extended follow-up periods are needed to confirm these results and refine the technique. This minimally invasive approach may represent a significant advancement in spine surgery, offering a safer and more effective treatment option for patients with degenerative lumbar conditions.