Percutaneous Endoscopic Transforaminal Lumbar Interbody Fusion (PETLIF): Current Techniques, Clinical Outcomes, and Narrative Review

Abstract

Full endoscopic techniques are becoming more popular for degenerative lumbar pathologies. Percutaneous endoscopic lumbar interbody fusion (PETLIF) is a minimally invasive surgical technique for spondylolisthesis and lumbar spinal canal stenosis with instability. Nagahama first introduced PETLIF in 2019. This study investigated the clinical outcomes and complications of 24 patients who underwent PETLIF in our facility and compared them with previous studies. Literature searches were conducted on PubMed and Web of Science. The PETLIF surgical technique involves three steps to acquire disc height under general anesthesia. The procedure includes bone harvesting, spondylolisthesis reduction, endoscopic foraminoplasty, disc height expansion using an oval dilator, and intervertebral disc curettage. A cage filled with autologous bone is inserted into the disc space and secured with posterior fixation. Patients underwent PETLIF with an average operation time of 130.8 min and a blood loss of 24.0 mL. Postoperative hospital stays were 9.5 days. Improvement in VAS, disc height, spinal canal area, and % slip was observed, while lumbar lordosis remained unchanged. Complications included end plate injury, subsidence, and exiting nerve root injury. The differences between PETLIF and the extracted literature were found in patients’ age, direct decompression, epidural or local anesthesia, approach, order of PPS, and cage insertion. In conclusion, PETLIF surgery is a practical, minimally invasive surgical technique for patients with lumbar degenerative diseases suffering from back and leg pain, demonstrating significant improvements in pain scores. However, it is essential to carefully consider the potential complications and continue to refine the surgical technique further to enhance the safety and efficacy of this procedure.