Awaken lumbar interbody fusion

As can be deduced from the title of the article, "Endoscopic transforaminal lumbar intervertebral fusion without general anesthesia: operative and clinical outcomes in 100 consecutive patients with minimal follow-up of one year", by John Paul G. Kolcun et al. (published today in Neurosurgical Focus, gives the reader a glimpse of the effectiveness of lumbar surgery in some patients when it is performed without general anesthesia, without surgery or after a long convalescence in the hospital.

Context. Transforaminal Lumbar Interbody Fusion (TLIF) is a surgical procedure used to stabilize the spine and reduce back pain in patients with one or more damaged spinal discs or other degenerative changes in the spine affecting adjacent nerves. By accessing the spine by an incision in the back of the patient, the surgeon removes the damaged disc, located between two vertebrae, and replaces it with a spacer to allow adequate height between adjacent vertebrae. This spacer, often a cage, contains a bone graft and possibly a bone-inducing protein preparation. Surgeons often insert pedicle screws and stems or attach additional bone grafts to form a bridge between neighboring vertebrae. Over time, the new bone grows, fusing the two vertebrae.

TLIF can be performed at a spinal or multilevel level. The procedure is most often performed in the form of open surgery, but in recent years it has also been performed with minimally invasive percutaneous techniques, with now the integration of endoscopic methods for part of the procedure.

People with severe lower back pain need help. Those who face surgery have generally exhausted their medical and physical treatments. However, the prospect of surgery can be daunting: extended hospital stay, significant blood loss during surgery, postoperative pain and fear of becoming opioid-dependent.

A minimally invasive surgery and not requiring general anesthesia would be an attractive option for most people in this situation.

Current study. In this article, the authors reviewed the first 100 cases of endoscopic, minimally invasive and minimally invasive transforaminal transforaminal lumbar interbody fusion (MIS-TLIF) (MIS-TLIF) at the University of Waterloo Hospital. Miami, all made by leading author Michael Y. Wang. , MD, between July 2014 and August 2017. The authors also provide details on how this procedure differs from open conventional surgeries and MIS-TLIF.

The MIS-TLIF endoscopic monitoring achieves vertebral fusion in selected patients without the need for general endotracheal anesthesia and with dissection of muscles and other soft tissues significantly lower than that performed in open surgery. Patients ideally receive mild to moderate sedation and local badgesia; while remaining aware, they are able to provide information to the surgeon and the anesthetist. The endoscopic approach limits damage to surrounding tissues, making postoperative recovery faster, less painful and perhaps less prone to complications.

The patients in this report included 56 women and 44 men, aged 66 on average. TLIF at one level was performed in 84 patients and TLIF at two levels out of 16. TLIF's most common site was L4-5. To evaluate the clinical and operative outcomes, the authors examined the length of stay of patients in the hospital, the duration of surgery, intraoperative blood loss and patient scores at the disability index. Oswestry, both before surgery and at the last follow-up examination. (1 year or more).

The authors indicate that, compared to conventional MIS-TLIF reports in the literature, the durations of hospital stays (average of 1.4 days) and surgical procedures (average of 84.5 minutes for single-level surgical procedures and 128.1 hours for two-level procedures), and intraoperative blood loss (mean of 65.4 ml for single-level procedures and 74.7 ml for two-level procedures) was lower in MIS-TLIF case endoscopic awake. They also claim that after a minimum follow-up of one year, no mechanical instability was suggested by clinical examination and X-ray imaging.

The difference between the preoperative (mean 29.6) and postoperative (mean 17.2) scores of the patients in this study showed clinical improvement with statistically significant significance (p

There were few complications in this series. In four patients, the surgical plan was revised to include a general endotracheal anesthesia; the surgery was successful in all cases. Four other patients had early postoperative complications requiring revision: cage migration (two cases), bone infection and final plateau fracture. Three of the four postoperative complications occurred during the first half of the study period.

The MIS-TLIF endoscopic procedure was developed before the University of Miami put in place protocols based on the principles of Enhanced Surgery Recovery (ERAS). The authors point out, however, that this procedure is in line with the objectives of ERAS ("minimal soft tissue destruction, reduced blood loss and less use of intraoperative narcotic badgesia") and that they expect additional benefits for future patients. undergo awake endoscopic SIM – TLIF combined with non-surgical ERAS components.

Asked about the study, Dr. Wang said, "Every year, more and more people are suffering from spinal disease in America and around the world. our patients. We believe that this study demonstrates that the TLIF watch procedure is a new technique that allows patients to relieve disabling pain without disabling surgery. "

The document is accompanied by an editorial of Drs. Marcus D. Mazur and Andrew T. Dailey, focusing on paper and its integration of minimally invasive surgery awake and principles of ERAS. Improved recovery after spinal surgery is the topic of this month Neurosurgical Focus. "Endoscopic lumbar transforaminal intervertebral fusion without general anesthesia: operative and clinical outcomes in 100 consecutive patients with minimal follow-up of one year" is one of 15 articles in this issue.

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Journal of Neurosurgery