Authors: Dr.Vijaya. B.T, Dr.Sunil Nadkarni, Dr.Satishchandra Gore

Authors Affiliations:  Hardikar hospital, 1160/61, University road, Pune-411005, Maharashtra

Address of correspondence: Dr.Vijaya. B.T, Hardikar hospital, 1160/61, University road, Pune-411005, Maharashtra


Abstract                                                                                                                 

Introduction

TLIF has become a well-established method of surgical treatment of lumbar spinal disorders such as Spondylolisthesis and discogenic back pain. Potential complications include wide exposure resulting in muscle stripping and denervation, risk of nerve root injury during retraction, wrong level approach and general anaesthesia related complications.

We propose a new method HLIF (hybrid TLIF) which merges two proven techniques, to improve the safety and accuracy of the intervention, namely transforaminal percutaneous endoscopic discectomy with percutaneous pedicle screws and cage under sensory epidural anaesthesia. This method can avoid the complications related to exposure, neurological deficits and wrong level.

Material and Methods

40 patients with lumbar spinal stenosis and disc degeneration were treated using HLIF procedure, and followed up for one year.

Patients were made prone in awake state after placement of an epidural catheter (No drug was given at this stage). Under C-arm guidance and local anaesthesia needle is introduced transforaminallystarting 10 cm from the midline into the posterolateral corner of the affected disc space. Inj.Ropivacaine was then given via the epidural catheter.Transforaminal endoscopic decompression and disc space preparation is then performed followed by insertion of interbody spacer filled with allograft bone followed by bilateral percutaneous screws insertion to complete the procedure.

The clinical outcomes were evaluated using the Oswestry Disability index (ODI).

Oswestry Disability Index Number of Patient (%)
0-20 % No or Minimal disability 36 (90%)
21-40 % Moderate disability 4 (10%)
41-60 % Severe disability Nil
61-80% crippled Nil
81-100 % Bed bound Nil

Discussion

The advantages of HLIF over the traditional TLIF include:

  • Awake neuro monitoring with local anaesthesia supplemented by short sensory epidural anaesthesia during introduction of screws and cage
  • Exiting nerve root protected by dilator avoids neural injury
  • Insertion of dilator and canula at the affected space under guidance of C-arm allows us to focus and target pathological segment.
  • Irrigating fluid of endoscopy separates muscles allowing clear identification of muscle planes and as a result minimum muscle and soft tissue damage.
  • Visualisation of the interbody spacer in the disc space during insertion.
  • Visualization of disc or bone fragments inadvertently pushed to opposite side and their removal was possibleendoscopically.

Conclusion

HLIF adds to ease, safety and precision of doing lumbar interbody fusion and can be done under regional anaesthesia.It is a safe and effective alternative to open surgical modalities.

How to Cite this Abstract
Vijaya B.T. Hybrid procedure for treatment of lumbar or lumbosacral Spondylolisthesis
International Journal of Conference Proceedings. March 2015;(2015):28