Endoscopic Transforaminal Lewlif™ Interbody Fusion with a Standalone Expandable Interbody Fusion Cage

Abstract

Endoscopic spinal fusion is on the horizon. Many surgeons have offered various endoscopically assisted decompression and fusion surgeries that consist of an interbody device and posterior supplemental screws. Stabilization of the spine via an anterior column fusion implant has excellent advantages of improving the fusion rate via bone graft containment. It can enhance spinal alignment and assist in direct and indirect decompression of neural elements via restoring normal lumbar curvature and neuroforaminal height. However, further use of posterior supplemental fixation has the disadvantage of adding to the operation's complexity in blood loss, time, equipment needs, and complications. Therefore, a simplified standalone anterior interbody fusion procedure to be carried out through the transforaminal approach via a small posterolateral skin incision was of interest to the authors of this chapter, who are introducing the complete endoscopic implantation of a threaded expandable cylindrical fusion cage. This fusion system was developed to mitigate subsidence and migration problems seen with non-threaded lumbar interbody fusion cages, many of which require posterior pedicle screw fixation. This chapter describes step-by-step transforaminal decompression fusion technique suitable for an outpatient ambulatory surgery center setting.