Feasibility of full percutaneous segmental stabilization of the lumbar spine with a combination of an expandable interbody cage and an interspinous spacer: Preliminary results

Abstract

Introduction: We evaluated the feasibility of a full percutaneous approach with an expandable interbody cage and an interspinous spacer for a segmental stabilization of the anterior and posterior columns of the lumbar spine, respectively, with local anesthesia. Methods: Patients were prospectively included between 2012 and 2018 in this single-center, feasibility case series. An expandable interbody cage was inserted with endoscopy-based, facet-sparing percutaneous transforaminal lumbar interbody fusion (pTLIF). An interspinous spacer was percutaneously placed through the same skin incision. Pre- and postoperative Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) outcomes at 1, 3, 6, 12, and 24 months were obtained and evaluated with the Student t test. Postoperative outcome was classified according to modified Macnab criteria. Results: A total of 16 patients were included, presenting mean preoperative scores for VAS back of 6.9 6 2.5, VAS leg 7.9 6 1.2, and ODI 30.1 6 4.5. Postoperative mean scores for VAS back of 1.9 6 2.1, VAS leg 2.1 6 3.4, and ODI 14.8 6 13.0 significantly (P, .001) decreased with a mean follow-up of 18.1 6 16.6 months (range 1-65.2). Postoperative outcome was excellent and good for 13 (81%) cases, fair for 2 (13%), and poor for 1 (6%) case with a preoperative spondylolisthesis, which required revision surgery due to persisting instability. Postoperative complications included 3 cases with transitory, ipsilateral dysesthesia and 2 cases with radiologic cage subsidence but no clinical symptoms. Median postoperative time until hospital discharge was 16 hours. Conclusion: Our preliminary results for this full percutaneous technique show a similar outcome compared to conventional surgery with a fast patient recovery and early postoperative hospital discharge, opening the way to instrumented, outpatient surgery.