Objective: To demonstrate the feasibility, risks and outcomes of percutaneous oblique extraforaminal lumbar interbody fusion (ELIF) technique. There is a growing interest in using less invasive and less exposure surgery techniques but very little has been written on an extraformainal approach for decompression and interbody fusion through Kambin’s Triangle with the advantage of sparing the facets and lamina plus dissection of the multifidus muscles.
Methods: We reviewed the medical records of 10 consecutive patients undergoing an extraforaminal approach to the lumbar disc space for placement of a cannulated and bulleted interbody cage for fusion followed by percutaneous transfacet pedicle screw fixation. The postoperative outcome scores and complications were obtained at the final follow up encounter were used to determine clinical improvement.
Results: Mean age was 47.5 years and BMI was 29.8 kg/m2 with males comprising 10% of the patient population. Three spinal levels were operated on including L3-L4, L4-L5, and L5-S1. Patients demonstrated improved VAS scores from a mean of 7.8 to 4, p= 0.001 and ODI decreased from 53% to 24.4 %, p= 0.02 at 24 months. Complications included three patients with postoperative neuropathy, one patient had a proud cage due to over packing of the disc space, and one patient had a nonunion and a subsequent revision.
Conclusions: Results from this study show less than favorable overall outcome with 50% of patients experiencing neurological complications when using this extraforaminal approach. Operating on the L5-S1 level limits operating space and is not recommended for this approach.
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