Digital Tubular-Based Camera-Assisted Minimally Invasive Transforaminal Lumbar Interbody Fusion: 2-Dimensional Operative Video

Abstract

A 64-year-old female patient presented with a progressively worsening low back pain with secondary complaints of radiating bilateral lower extremity pain for 11 months. Before her surgical evaluation, the patient attempted physical therapy, multimodal medical therapy, and epidural steroid injections at lumbar 4–5. The patient initially experienced significant relief, but after repeated injections, the lumbar epidural steroid injections were no longer effective. Imaging demonstrated significant segmental stenosis due to multifactorial compression as a result of facet hypertrophy, ligamentum overgrowth, and a broad-based disk herniation. Given the failure of nonoperative management, a right-sided lumbar 4–5 minimally invasive transforaminal lumbar interbody fusion was performed using a digital tubular-based camera to allow advanced visualization with multidirectional and expanded field of view, reported on monitors. The patient consented to the procedure. The participants and any identifiable individuals consented to publication of his/her image. The camera was placed on the distal end of the tubular port with a 15-mm working channel. The tubular port was stabilized with an attachment to a percutaneously placed pedicle screw on the contralateral side. Standard instruments including a high-speed drill, Kerrison rongeur, and dilators were used to access the disk space. After a thorough disk prep, an expandable interbody device was placed, followed by the remaining pedicle screws and rods. The patient was ready to be discharged from the hospital the following day with near-complete resolution of preoperative symptoms. This report highlights the use of advanced surgical visualization in combination with a tubular access to perform minimally invasive transforaminal lumbar interbody fusion.