Abstract
Background
Endoscopically assisted screw fixation with lumbar interbody fusion is rarely performed. We succeeded in implanting the cortical bone trajectory (CBT) screws under the guidance of unilateral biportal endoscopy (UBE).
Method
We attempted endoscopically assisted screw fixation in a patient with degenerative spondylolisthesis. Through a third portal, ipsilateral CBT screws were implanted without complications.
Conclusions
We successfully performed unilateral biportal endoscopic lumbar interbody fusion (ULIF) with CBT and reversed CBT screws. Compared with percutaneous pedicle screw (PPS) placement, this procedure is a minimally invasive, endoscopic alternative that allows precise screw placement.
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Data availability
The original data and material presented in the study are included in the article/Supplementary Material; further inquiries can be directed to the corresponding author.
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References
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Funding
This work was supported by the National Key R&D Program of China (2019YFC0121400).
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Authors and Affiliations
Contributions
Conceptualization: WZ and HP; methodology: WZ; resources: JL; writing—original draft preparation: CZ; writing—review and editing: WZ; supervision: WZ and HP; project administration: WZ. All authors contributed to the article and approved the submitted version.
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The studies involving human participants were reviewed and approved by the Institutional Review Board of Hangzhou Traditional Chinese Medicine Hospital Affiliated with Zhejiang Chinese Medical University.
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The patients provided their written informed consent to participate in this study.
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Written informed consent was obtained from the patient for publication of this technical note and any accompanying images.
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The authors declare no competing interests.
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Key points
1. We successfully performed unilateral biportal endoscopic-assisted cortical trajectory screw fixation (ULIF).
2. By performing a contralateral facetectomy through the third portal [6], theoretically, it is also possible to achieve endoscopic CBT and reversed CBT screw implantation on the contralateral side.
3. In endoscopic CBT and reversed CBT screw implantation, the surgical field is small, and adequate exposure of an accurate entry point minimizes the risk of muscle and facet joint injury while reducing operative time and radiation exposure.
4. The cortical bone at the entry point can be entered using an endoscopic high-speed burr to avoid slipping when inserting screws.
5. The CBT screw can be safely inserted by an assistant on the contralateral side under endoscopic monitoring.
6. The screw was first inserted on the right side to avoid obstructing the view for endoscopic observation.
7. The strength of solid CBT screws may be greater than that of hollow pedicle screws.
8. When the screw-rod system is inserted, it is advisable to suture the working portal temporarily to prevent the formation of a vortex, which may cause the surgical field to appear blurry.
9. The “stop irrigation test” was helpful in determining the bleeding points, and complete haemostasis was recommended to prevent epidural haematoma formation.
10. Extensive experience in biportal endoscopic lumbar interbody fusion has aided in performing this new procedure.
Supplementary Information
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Zhu, C., Liang, J., Pan, H. et al. Biportal endoscopic-assisted cortical bone trajectory screw placement and lumbar interbody fusion. Acta Neurochir 166, 74 (2024). https://doi.org/10.1007/s00701-024-05986-3
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DOI: https://doi.org/10.1007/s00701-024-05986-3