Lumbar Spine

Endoscopic Uninstrumented Transforaminal Lumbar Interbody Fusion with Allograft for Surgical Management of Endstage Degenerative Vacuum Disc Disease

Author(s): Álvaro Dowling*, James Gerald Hernández Bárcenas and Kai-Uwe Lewandrowski

Pp: 242-255 (14)

DOI: 10.2174/9789815051537122020017

* (Excluding Mailing and Handling)

Abstract

Not every patient with painful end-stage degenerative disc disease is a
candidate for instrumented fusion surgery or wants it regardless of whether it is carried
out through open, mini-open, or minimally invasive incisions. The authors were
intrigued by their anecdotal observation that elderly patients with painful vacuum discs
serendipitously found during endoscopic decompression went on to successful fusion
and enjoyed substantial long-term pain relief. Therefore, we investigated the feasibility
of a transforaminal endoscopic decompression and un-instrumented lumbar interbody
fusion procedures with cancellous bone allograft. A total of 29 patients had their
vacuum discs directly visualized with a modified hybrid transforaminal technique
employing procedural components of both the outside-in and the inside-out technique.
Intraoperative endoscopic visualization of a painful, hollow collapsed, rigid
intervertebral disc space allowed grafting it with cancellous allograft chips. In addition
to the two-year radiographic assessment of fusion, patients were evaluated with VAS,
ODI, and modified MacNab criteria. At the final follow-up, mean VAS and ODI scores
reduced from 7.34 ± 1.63 and 50.03 ± 10.64 preoperatively to 1.62 ± 1.741 and 6.69 ±
4.294 postoperatively (p < 0.0001). According to Macnab criteria, excellent and good
clinical outcomes were obtained in 34.5% and 62.1% of patients, respectively. Only
one patient had minimal improvement from “Poor” preoperatively to “Fair”
postoperatively. Computed tomography assessment of interbody fusion at the last
follow-up showed successful fusion in 91.4% of patients. Based on these study
observations, the authors concluded that an un-instrumented interbody fusion by
packing a hollow interspace with cancellous bone allograft chips could be an adjunct to
endoscopic foraminal lateral recess decompression select patients with validated
painful, collapsed, and rigid motion segments.


Keywords: Allograft, Endoscopic lumbar decompression, Interbody fusion.

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      • 14. app/Models/Subject.php:238
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      • 17. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
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      • 11. app/Models/ContentAccess.php:647
      • 12. app/Http/Controllers/ChapterController.php:1465
      • 13. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 14. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
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      • 11. app/Models/ContentAccess.php:647
      • 12. app/Http/Controllers/ChapterController.php:1478
      • 13. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 14. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
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      • 13. app/Models/UserAccess/UserAccess.php:1266
      • 14. app/Http/Controllers/ChapterController.php:1518
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Trial Access" as access_base_text, CASE j.type WHEN 111 THEN true ELSE false END as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_trail` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 51595851 and j.to_ip >=51595851 )) and ((j.from_date <= 1739988357 and j.to_date >= 1739988357 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 16887) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Subscribed" as access_base_text, false as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_corporate` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 51595851 and j.to_ip >=51595851 )) and ((j.from_date <= 1739988357 and j.to_date >= 1739988357 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 16887) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Token Based Access" as access_base_text, false as terms_popup, "R" as content_download_type, j.uc_id as restricted_user_access_key, "v" as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_token` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 51595851 and j.to_ip >=51595851 )) and ((j.from_date <= 1739988357 and j.to_date >= 1739988357 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 16887)
      600μsalphaeurekaselec_live_10_06_2022UserAccess.php#1266
      Backtrace
      • 13. app/Models/UserAccess/UserAccess.php:1266
      • 14. app/Http/Controllers/ChapterController.php:1549
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • select b.banner_link, b.banner_name, b.banner_script, b.banner_remarks, b.banner_file_name, b.banner_placement, bd.content_type, bd.content_id from `tbl_banner` as `b` inner join `tbl_banner_detail` as `bd` on `bd`.`banner_id` = `b`.`banner_id` inner join `users` as `u` on `u`.`id` = `b`.`updated_by` where `b`.`banner_ebook` = 1 and `bd`.`content_type` = 'B' and `bd`.`content_id` = 3335 and `b`.`banner_from_date` <= 1739988357 and `b`.`banner_to_date` >= 1739988357 and `b`.`banner_status` = 'A' order by `b`.`banner_id` desc
      1.09msalphaeurekaselec_live_10_06_2022Banner.php#95
      Bindings
      • 0: 1
      • 1: B
      • 2: 3335
      • 3: 1739988357
      • 4: 1739988357
      • 5: A
      Backtrace
      • 13. app/Models/Banner.php:95
      • 14. app/Http/helpers.php:404
      • 17. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 18. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    • select count(*) as aggregate from `uc_cart_products` where cart_id='bfdaa3d58053263068293a3ab380a5c5'
      230μsalphaeurekaselec_live_10_06_2022Cart.php#271
      Backtrace
      • 15. app/Models/Cart.php:271
      • 16. view::layouts._header:260
      • 18. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 20. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    App\Models\Keywords
    3Keywords.php#?
    App\Models\Chapter
    1Chapter.php#?
    App\Models\Ebook
    1Ebook.php#?
        _token
        EpWi0wWJG70jjx7isxoLxK1Wpb77b4UNEhpzwfuh
        uc_cart_id
        bfdaa3d58053263068293a3ab380a5c5
        _previous
        array:1 [ "url" => "https://alpha.eurekaselect.com/chapter/16887" ]
        _flash
        array:2 [ "old" => [] "new" => [] ]
        PHPDEBUGBAR_STACK_DATA
        []
        path_info
        /chapter/16887
        status_code
        200
        
        status_text
        OK
        format
        html
        content_type
        text/html; charset=UTF-8
        request_query
        []
        
        request_request
        []
        
        request_headers
        0 of 0
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        request_cookies
        0 of 0
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        response_headers
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        ClearShow all
        Date ↕MethodURLData
        #12025-02-19 18:05:57GET/chapter/16887112195