Endoscope-Assisted Spine Surgery: A Comprehensive Review of Clinical Applications and a Lateral Interbody Fusion Case Illustration

TL;DR

Endoscopic spine surgery provides a minimally invasive option for various spinal procedures, offering benefits like reduced tissue damage and faster recovery.

Contribution

The paper presents a case illustration of endoscopic XLIF, highlighting its effectiveness and safety in complex spinal surgery.

Findings

Endoscopic discectomy results in shorter operative times and lower infection rates compared to open microdiscectomy.

Endoscopic XLIF achieved ideal cage placement and alignment with no complications in a complex patient case.

Endoscopic techniques for interbody fusion match MIS outcomes while further reducing blood loss and hospital stay.

Abstract

Endoscopic spine surgery offers a minimally invasive alternative to traditional microsurgical techniques across a spectrum of pathologies, namely discectomy, interbody fusion, and laminectomy, by leveraging small incisions, reduced tissue disruption, and direct visualization. Endoscopic discectomy yields shorter operative times, lower infection rates, and comparable pain and functional outcomes versus open microdiscectomy. Similarly, endoscopic laminectomy for lumbar stenosis provides equivalent decompression with less postoperative pain and faster mobilization than microscopic or open approaches. In the realm of interbody fusion, endoscopic techniques (including transforaminal lumbar interbody fusion, lateral lumbar interbody fusion, and extreme lateral interbody fusion (XLIF) variants) achieve fusion rates and radiographic corrections on par with minimally invasive surgical (MIS) techniques, while further minimizing blood loss, length of stay, and anesthesia exposure. We present a 67-year-old male patient with prior T10-11 and T11-12 fusions, hemilaminectomies, and dorsal column stimulator hardware who developed adjacent-segment L3-4 stenosis. An endoscopic XLIF was performed under fluoroscopic and neuromonitoring guidance. The patient experienced an uncomplicated procedure with immediate preservation of neurologic function and postoperative imaging confirming ideal cage placement and alignment. Endoscopic spine surgery, exemplified by this XLIF case, combines the benefits of MIS with an expanded view of the surgical field. With proper patient selection and adherence to evolving technical guidelines, these techniques continue to offer promising outcomes, reinforcing their role as a transformative modality in modern spine surgery.

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