Indirect Decompression Using the Keyhole Transfacet Full-Endoscopic Lumbar Interbody Fusion: Technical Note and...

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Minimally Invasive Spine Surgery

Background:

• Existing full-endoscopic lumbar interbody fusion (FE-LIF) techniques include facet-preserving and facet-sacrificing approaches.
• Emerging transfacet endoscopic techniques often rely on direct neural element decompression.
• The efficacy of indirect decompression via transfacet endoscopic fusion remains underexplored.

Purpose of the Study:

• To describe a novel keyhole transfacet FE-LIF technique using indirect decompression.
• To present the early clinical application and radiographic outcomes of this technique.

Main Methods:

• A keyhole transfacet osseous corridor is created using an endoscopic round burr for limited facetectomy.
• Disc removal, endplate preparation, and cage insertion are performed without direct nerve root manipulation.
• Indirect decompression is achieved through the created corridor, with optional direct decompression post-cage placement.

Main Results:

• The technique was applied to 4 patients with diverse lumbar pathologies including spondylolisthesis, disc collapse, deformity with stenosis, and pseudarthrosis.
• All patients underwent keyhole transfacet FE-LIF with indirect decompression.
• A minimum follow-up of 1 year was achieved for all cases.

Conclusions:

• The keyhole transfacet endoscopic fusion technique enables minimally invasive indirect decompression in the prone position.
• This approach is suitable for various degenerative lumbar conditions.
• Adjunctive direct decompression can be performed during the same surgical setting if necessary.