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"Pin Method" for Endoscopic Lumbar Interbody Fusion.

Ting-Chun Huang¹

¹Department of Orthopaedic Surgery, National Taiwan University BioMedical Park Hospital, Chutung, Taiwan.

Journal of Neurological Surgery. Part A, Central European Neurosurgery

|May 27, 2021

Summary

A novel "pin method" enhances safety in endoscopic lumbar interbody fusion by using guide pins for cage insertion, preventing neural incarceration. This technique offers a secure and versatile approach for spinal fusion procedures.

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Area of Science:

Spine surgery
Minimally invasive procedures
Orthopedic surgery

Background:

Endoscopic lumbar interbody fusion (ELIF) offers comparable fusion rates to traditional methods.
Direct visual control is critical during cage insertion in ELIF to prevent neural structure incarceration.
Existing methods using retractors or cannulas create blind spots and risk displacement, compromising safety.

Purpose of the Study:

To introduce and evaluate a novel, safe, and accessible technique for cage insertion during endoscopic lumbar interbody fusion.
To address the limitations of current methods in preventing neural incarceration and ensuring secure cage placement.

Main Methods:

The "pin method" involves inserting two flexible metallic guide pins through the annulotomy into the disc space under direct endoscopic visualization.

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These guide pins create a track and a see-through barrier, guiding cage insertion and preventing neural impingement.

The pin configuration can be adjusted (parallel, perpendicular, single, or multiple pins) as needed.

Main Results:

The pin method was successfully applied in two cases of L4/L5 grade 2 spondylolisthesis with neurogenic claudication.
Patients demonstrated significant improvements in pain (Visual Analog Scale), function (Oswestry Disability Index), quality of life (EuroQol-5D), and clinical outcomes (modified Macnab score) at 1-year follow-up.
The method proved versatile, applicable to full-endoscopic and biportal surgery, various approaches, and different cage sizes/shapes.

Conclusions:

The "pin method" is an original, cost-effective, accessible, and safe technique for endoscopic lumbar interbody fusion.
It effectively prevents neural incarceration during cage insertion, enhancing surgical safety.
This method offers flexibility and broad applicability across different surgical scenarios and implant types.