Awake Endoscopic Spinal Fusion Appears to Be Safe, Effective
MONDAY, April 1, 2019 -- Awake endoscopic minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) performed without general anesthesia is safe and seems effective for lumbar fusion, according to a study published online April 1 in Neurosurgical Focus.
John Paul G. Kolcun, from the University of Miami Miller School of Medicine, and colleagues reviewed the first 100 patients who underwent awake endoscopic MIS-TLIF, performed while patients were sedated without intubation or use of general anesthetic or narcotic agents. Discectomy and placement of an expandable interbody graft were performed endoscopically and were followed by implantation of a percutaneous pedicle screw.
The researchers found that 84 and 16 patients underwent single-level and two-level fusion, respectively. L4-5 was the most commonly fused level, representing 77 percent of all fused levels. For all patients, the mean length of hospital stay was 1.4 ± 1.0 days. There were four deaths, all from complications unrelated to surgery. The mean preoperative and postoperative Oswestry Disability Index scores were 29.6 ± 15.3 and 17.2 ± 16.9, respectively, representing a significant mean reduction of −12.3. The surgical plan was revised to include general endotracheal anesthesia intraoperatively in four cases and was successfully completed. Two cases of cage migration, one case of osteomyelitis, and one case of endplate fracture were reported.
"We believe that our procedure provides patients with a safe and efficacious option for lumbar fusion without the morbidity associated with an open surgery," the authors write.
Several authors disclosed financial ties to the medical device industry.
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Posted: April 2019