Open AccessStandalone lordotic endoscopic wedge lumbar interbody fusion (LEW-LIF™) with a threaded cylindrical peek cage: report of two cases
Author(s) -
Jorge Felipe Ramírez León,
Álvaro Silva Ardila,
José Gabriel Rugeles Ortíz,
Carolina Ramírez Martínez,
Gabriel Oswaldo Alonso Cuéllar,
Jefferson Infante,
KaiUwe Lewandrowski
Publication year - 2020
Publication title -
journal of spine surgery
Language(s) - English
Resource type - Journals
eISSN - 2414-469X
pISSN - 2414-4630
DOI - 10.21037/jss.2019.06.09
Subject(s) - peek , cage , wedge (geometry) , fusion , materials science , lumbar , orthodontics , medicine , surgery , structural engineering , composite material , physics , engineering , optics , linguistics , philosophy , polymer
We report two cases of a standalone lordotic endoscopic wedge lumbar interbody fusion (LEW-LIF™) with a stress-neutral non-expandable cylindrical threaded polyether ether ketone (PEEK) interbody fusion implant. Patients underwent full-endoscopic transforaminal decompression and fusion for symptomatic lateral recess stenosis due to disc herniation, and hypertrophy of the facet joint complex and ligamentum flavum and no more than grade I spondylolisthesis. Lumbar interbody fusion with cages traditionally calls for posterior supplemental fixation with pedicle screws for added stability. A more simplified version of lumbar decompression and fusion without pedicle screws would allow treating patients suffering from stenosis and instability induced sciatica-type low back and leg pain in an outpatient ambulatory surgery center setting (ASC). This would realize a significant reduction in cost as well as the burden to the patient with decreased postoperative pain and earlier return to function. A 62-year-old female patient had surgery at L4/5 for a 6-year history of worsening right sided sciatica-type leg- and low back pain. Another 79-year-old female had the same surgical management at L4/5 for a 5-year history of unrelenting left-sided spondylolisthesis-related symptoms. Both patients had an uneventful postoperative course until the last available follow-up of 24 weeks with greater than 60% VAS and Oswestry disability index (ODI) reductions. There was no evidence of implant expulsion, subsidence, or postoperative instability. We concluded that standalone outpatient lumbar transforaminal endoscopic interbody fusion with a non-expandable threaded cylindrical cage is feasible, and favorable clinical outcomes provide proof of concept to study long-term clinical outcomes in larger groups of patients.