Our Summary

This research paper discusses a new technique, called the “pin method,” for a type of back surgery known as endoscopic lumbar interbody fusion. This surgery involves using a hollow metal cage to support the spine and promote the growth of new bone.

Endoscopic lumbar interbody fusion can have the same success rate as other minimally invasive surgeries. However, when inserting the cage, it’s crucial to avoid trapping or damaging any nerves. Traditional methods, which use a retractor or cannula to create a path for the cage, can be risky as these tools can create blind spots or shift during surgery.

The “pin method” uses two flexible metal guide pins which are inserted through a cut in the skin, into the disc space, until they reach a ligament at the front of the spine. The surgeon can watch this process under direct endoscopic vision. The pins can be adjusted as needed and act as both a track for the cage and a see-through barrier to protect the nerves.

The study shares the results of two patients who had this surgery to treat a condition called spondylolisthesis, which caused them nerve-related leg pain. After a year, both patients reported significant improvements in their pain and disability scores. The pin method is a cheap, safe technique that can be used in various surgical approaches and is not limited by the size or shape of the cage used.

FAQs

  1. What is the “pin method” used in endoscopic lumbar interbody fusion?
  2. How does the “pin method” differ from traditional methods in endoscopic lumbar interbody fusion?
  3. What are the reported benefits of using the “pin method” in endoscopic lumbar interbody fusion based on this study?

Doctor’s Tip

A helpful tip a doctor might tell a patient about lumbar fusion is to discuss with their surgeon the different techniques available, such as the “pin method,” and to ensure that the chosen method minimizes the risk of nerve damage during the procedure. It is important for patients to understand the potential risks and benefits of each technique in order to make an informed decision about their treatment. Additionally, patients should follow their surgeon’s post-operative instructions closely to optimize their recovery and long-term outcome.

Suitable For

Patients who are typically recommended for lumbar fusion surgery include those with:

  1. Degenerative disc disease
  2. Herniated disc
  3. Spondylolisthesis
  4. Spinal stenosis
  5. Fractures
  6. Tumors
  7. Infections
  8. Failed previous back surgery

Patients who have not had success with conservative treatments such as physical therapy, medications, and injections may be candidates for lumbar fusion surgery. Additionally, patients who experience severe and chronic back pain, weakness, numbness, or tingling in the legs may also be recommended for lumbar fusion. It is important for patients to consult with a spine specialist to determine if lumbar fusion is the appropriate treatment option for their specific condition.

Timeline

Before lumbar fusion:

  1. Patient experiences chronic back pain that does not improve with non-surgical treatments such as physical therapy or medication.
  2. Patient undergoes diagnostic tests such as X-rays, MRI, or CT scans to determine the cause of their pain.
  3. Patient consults with a spine surgeon who recommends lumbar fusion surgery as a treatment option.
  4. Patient undergoes pre-operative evaluations and medical clearance before scheduling the surgery.

After lumbar fusion:

  1. Patient undergoes the surgery, which involves removing damaged disc material and fusing two or more vertebrae together using a bone graft or cage.
  2. Patient stays in the hospital for a few days for post-operative monitoring and pain management.
  3. Patient follows a rehabilitation program that includes physical therapy to regain strength and function in the back.
  4. Patient is advised to avoid heavy lifting and high-impact activities for a period of time to allow the fusion to heal properly.
  5. Patient attends follow-up appointments with the surgeon to monitor their progress and address any concerns or complications.

What to Ask Your Doctor

  1. What is the success rate of endoscopic lumbar interbody fusion compared to other minimally invasive surgeries?
  2. How does the “pin method” differ from traditional methods of inserting the cage during surgery?
  3. What are the risks associated with traditional methods of lumbar fusion surgery?
  4. How does the “pin method” help to protect nerves during surgery?
  5. Are there any specific conditions or factors that make a patient a good candidate for the “pin method” of lumbar fusion?
  6. What is the recovery process like for patients who undergo endoscopic lumbar interbody fusion using the “pin method”?
  7. Are there any long-term effects or complications associated with this type of surgery?
  8. How does the cost of the “pin method” compare to traditional methods of lumbar fusion surgery?
  9. Are there any limitations to the size or shape of the cage that can be used with the “pin method”?
  10. What are the expected outcomes for patients who undergo endoscopic lumbar interbody fusion using the “pin method” for conditions like spondylolisthesis?

Reference

Authors: Huang TC. Journal: J Neurol Surg A Cent Eur Neurosurg. 2022 Nov;83(6):573-577. doi: 10.1055/s-0041-1726107. Epub 2021 May 27. PMID: 34044467