Virtual Conference
Spine Conference 2022

Yi Hung Huang

National Cheng Kung University Hospital Taiwan, Taiwan

Title: Percutaneous endoscopic transforaminal lumbar interbody fusion: novel technique of creating a safe quadrangular space for protection of exiting root


A The endoscopic spine surgery(ESS) is rapidly developed and ESS combined with TLIF(endo-TLIF) is a new trend due to the least traumatization. The safe zone of foramen (Kambin triangle) is limited, therefore implanting a cage into disc space away from the exiting root or dura injury is a major challenge. We developed a novel technique “sentinel pinning with a retractor” to protect the exiting root as application of tunnel protector and to implant a fixed size cage. The complete procedures were well described and effectiveness was surveyed.
Methods and material
We inserted contralateral percutaneous pedicle screws firstly, inserted the guide-pin to the SAP, performed foraminoplasty, discectomy and endplate preparing and inserted the sentinel pin docking at inferolateral border of the cranial vertebral body under the monitor of endoscope and fluoroscope. We harvested synthetic bone graft mixing with bone marrow aspirated from vertebral body and implanted a fixed size cage through the safe quadrangular space created by sentinel pin and lateral retractor. We secured the screws and rods finally. Demographics of patients, operation time and blood loss were recorded. Preoperative and postoperative Visual Analogue Scale of back and legs and ODI scores were quantitatively assessed at 1, 3, 6, and 12 months after surgery.
To Dec 2021, a total of 89 patients and 119 levels (mean age 63.4 y/o) were evaluated. The overall mean VAS score for back pain improved statically significantly, and mean ODI scores from 50.9 to 3.6 (P< 0.01) postoperatively was significantly improved with a mean follow-up of 15 months There was no postoperative permanent exiting root injury, iatrogenic durotomy and other neurogenic damage. 
Postoperative scores for endo-TLIF by this novel technique significantly improved and no disabled complications. The procedure could be considered as a safe and effective TLIF


Director of the Department of Orthopaedic Surgery Chia Yi Christian Hospital