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KMID : 1145220190160010082
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Neurospine
2019 Volume.16 No. 1 p.82 ~ p.95
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The Concept for A Standalone Lordotic Endoscopic Wedge Lumbar Interbody Fusion: The LEW-LIF
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Lewandrowski Kai-Uwe
Ransom Nicholas A.
Leon Jorge Felipe Ramirez
Yeung Anthony
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Abstract
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Objective: To review concepts of a standalone endoscopically assisted lumbar interbody fusion as a simplified method to treat spinal instability.
Methods: MacNab outcomes and complications were analyzed in a series of 48 consecutive patients who underwent standalone lordotic endoscopic wedge lumbar interbody fusion (LEW-LIF) for advanced lumbar disc degeneration, spinal stenosis, and spondylolisthesis.
Results: Forty-two of the 48 patients (77.8%) did well with excellent and good outcomes with a follow up of up to 20 months. Fair outcomes were reported by 4, and poor by another 2 patients, respectively. Six patients had endoscopic decompression procedures at another level. Four patients underwent open transforaminal lumbar interbody fusion revision surgery including the index level between 2 to 6 months postoperatively. An L5 vertebral body fracture was noted in 1 of these 4 patients. Another patient underwent removal of the extruded L3/4 cage. The cage fractured in one additional asymptomatic patient not requiring any intervention. No patient had a wound infection, or permanent sensory, or motor dysfunction. However, 29 patients developed a postoperative irritation of the dorsal root ganglion with burning leg pain typically between postoperative weeks 2 and 6. Symptoms were treated with activity modification, gabapentin, and transforaminal epidural steroid injections in 12 patients (25%).
Conclusion: Standalone LEW-LIF was associated with favorable clinical outcomes in the majority of patients. Patient-related predictors of less favorable outcomes considering normal variations as well as patho-anatomy may aid in the development of next-generation implants.
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KEYWORD
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Spinal diseases, Endoscopy, Spinal fusion
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