Endoscopic transforaminal lumbar interbody fusion: a comprehensive review

ABSTRACT

Introduction: Endoscopic spine surgery has been developed as a minimally invasive technique for decompression in patients with lumbar disc herniation or lumbar stenosis. Recent reports have described the use of endoscopic technology in lumbar fusion surgeries, especially for transforaminal lumbar interbody fusion (TLIF). This review aimed to summarize the current techniques of endoscopic TLIF and to discuss the benefits, limitations, and future perspectives of endoscopic lumbar fusion surgery.

Areas covered: This review covered the English-language medical literature published in Medline and focused specifically on endoscopic technologies incorporated into minimally invasive TLIF. The endoscopic TLIF techniques are categorized here according to the properties of the endoscope: percutaneous endoscopic TLIF, biportal endoscopic TLIF, and microendoscopic TLIF. Even though most authors have reported favorable clinical and radiological outcomes of endoscopic TLIF, such evidence originates mainly from case series.

Expert opinion: Although the current level of evidence is low and the technical relevance of the technique is controversial, the key concept and early results of endoscopic TLIF are promising. Technical advancements to improve safety and reduce technical complexity, as well as comparative cohort studies and randomized clinical trials with long-term follow-up are required to promote the adoption of endoscopic TLIF in clinical practice.

KEYWORDS:

• Biportal
• endoscopic
• minimally invasive
• percutaneous
• transforaminal lumbar interbody fusion
• spondylolisthesis
• stenosis

Article highlights

• Transforaminal lumbar interbody fusion (TLIF) is regarded as a standard technique for lumbar fusion surgery.

• Due to remarkable advancements in endoscopic technologies, minimally invasive TLIF (MIS-TLIF) techniques can now employ a surgical endoscope.

• Endoscopic TLIF techniques can be classified according to the properties of the endoscopic system used: percutaneous endoscopic, biportal endoscopic, and microendoscopic TLIF.

• Percutaneous endoscopic TLIF uses a working-channel endoscopic system and represents the most commonly used endoscopic TLIF technique in clinical practice.

• Biportal endoscopic TLIF uses a biportal endoscopic or arthroscopic system with a larger surgical field.

• Microendoscopic TLIF uses a microendoscope attached to the tubular retractor system and is similar to the traditional MIS-TLIF.

• This review of endoscopic TLIF identified only ten studies published in English to date, of which nine are case series and one is a technical note, indicating that the level of evidence is low.

• Further development of endoscopic instruments will help improve the safety of endoscopic TLIF and reduce the learning curve.

Acknowledgments

The authors would like to thank Jin Ah Kim, Jae Min Son, and Ho Kim for their support and assistance with this review.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.