Standalone lordotic endoscopic wedge lumbar interbody fusion (LEW-LIF™) with a threaded cylindrical peek cage: report of two cases.

We report two cases of a standalone lordotic endoscopic wedge lumbar interbody fusion (LEW-LIF™) with a stress-neutral non-expandable cylindrical threaded polyether ether ketone (PEEK) interbody fusion implant. Patients underwent full-endoscopic transforaminal decompression and fusion for symptomatic lateral recess stenosis due to disc herniation, and hypertrophy of the facet joint complex and ligamentum flavum and no more than grade I spondylolisthesis. Lumbar interbody fusion with cages traditionally calls for posterior supplemental fixation with pedicle screws for added stability. A more simplified version of lumbar decompression and fusion without pedicle screws would allow treating patients suffering from stenosis and instability induced sciatica-type low back and leg pain in an outpatient ambulatory surgery center setting (ASC). This would realize a significant reduction in cost as well as the burden to the patient with decreased postoperative pain and earlier return to function. A 62-year-old female patient had surgery at L4/5 for a 6-year history of worsening right sided sciatica-type leg- and low back pain. Another 79-year-old female had the same surgical management at L4/5 for a 5-year history of unrelenting left-sided spondylolisthesis-related symptoms. Both patients had an uneventful postoperative course until the last available follow-up of 24 weeks with greater than 60% VAS and Oswestry disability index (ODI) reductions. There was no evidence of implant expulsion, subsidence, or postoperative instability. We concluded that standalone outpatient lumbar transforaminal endoscopic interbody fusion with a non-expandable threaded cylindrical cage is feasible, and favorable clinical outcomes provide proof of concept to study long-term clinical outcomes in larger groups of patients.

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2020 Journal of Spine Surgery. All rights reserved.

Déclaration de conflit d'intérêts

Conflicts of Interest: The first author and his team of co-authors designed and marketed the standalone clyndrical interbody fusion cage and receive royalties and distributions from the sale of their product by Ortomac. Additional indirect conflicts of interest may exist due to honoraria, consultancies to other vendors and companies including Elliquence, LLC. The senior author has no direct or indirect conflicts and his involvement in this manuscript is not meant for or intended to endorse any products or push any other agenda other than the associated clinical outcomes with endoscopic standalone lumbar fusion. The senior author’s motive for assisting in the surgeries of the two patients involved in this case report and in the compilation of this clinically relevant information is by no means created and/or correlated to directly enrich anyone due to its publication. This publication was intended to substantiate contemporary endoscopic spinal surgery concepts to facilitate technology advancements.