Unilateral biportal endoscopy (UBE) has advanced to the point that endoscopic transforaminal lumbar interbody fusion (TLIF) can be performed safely and effectively [1–4]. The posterolateral interlaminar approach is utilized in biportal endoscopic TLIF. Expandable cage technology has also advanced significantly in lumbar fusion surgery. The advantage of expandable cages is that the cages are inserted in a smaller size and expand after insertion into the disc space. This property is useful in TLIF due to the narrow corridor available due to the dura, traversing, and exiting nerve roots [5]. These cages are designed narrow in width to allow for easier insertion through this narrow corridor without injuring the neural elements. Most expandable cages expand solely in height using a predetermined lordosis. However, these expandable cages are associated with a greater risk of subsidence into the vertebral bodies, potentially leading to loss of intervertebral disc height, alignment correction, and indirect decompression [6]. This may be due to narrow expandable cages that are placed in the center of the disc space where the endplates are the weakest.

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Biportal Endoscopic Transforaminal Lumbar Interbody Fusion Using an Expandable Cage

  • Don Young Park,
  • Dong Hwa Heo

摘要

Unilateral biportal endoscopy (UBE) has advanced to the point that endoscopic transforaminal lumbar interbody fusion (TLIF) can be performed safely and effectively [1–4]. The posterolateral interlaminar approach is utilized in biportal endoscopic TLIF. Expandable cage technology has also advanced significantly in lumbar fusion surgery. The advantage of expandable cages is that the cages are inserted in a smaller size and expand after insertion into the disc space. This property is useful in TLIF due to the narrow corridor available due to the dura, traversing, and exiting nerve roots [5]. These cages are designed narrow in width to allow for easier insertion through this narrow corridor without injuring the neural elements. Most expandable cages expand solely in height using a predetermined lordosis. However, these expandable cages are associated with a greater risk of subsidence into the vertebral bodies, potentially leading to loss of intervertebral disc height, alignment correction, and indirect decompression [6]. This may be due to narrow expandable cages that are placed in the center of the disc space where the endplates are the weakest.