Endoscopic Extreme Transforaminal Lumbar Interbody Fusion With Large Spacers: A Technical Note and Preliminary Report

This report describes a novel endoscopic fusion technique performed with unilateral biportal endoscopy (UBE) that is known as extreme transforaminal lumbar interbody fusion (eXTLIF) and is performed with a large spacer. We also present the short-term results of this procedure. Previous studies reported that minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) could achieve acceptable rates of fusion; therefore, it is often used for treating various degenerative lumbar diseases. Moreover, MIS-TLIF can be performed with a unilateral approach; hence, it is commonly performed with the UBE technique. The biportal endoscopic TLIF procedure is usually performed with a single spacer in the interbody space. It is important to insert the maximum amount of graft material into the preparation site via an autologous bone marrow transplant or any other suitable substance with spacer insertion. Because MIS-TLIF with UBE is performed in water, it might provide an inadequate environment for excellent fusion. Therefore, a modified method was used to increase the surface contact area and insert the maximum amount of bone material with a larger spacer. However, the use of a large spacer necessitates a larger spacer orifice. For this purpose, eXTLIF was performed, which inserts the spacer more laterally compared with the current TLIF position. We report the surgical method and short-term results, which have been satisfactory thus far. [Orthopedics. 2022;45(3):163-168.].