Full-Endoscopic Posterior Lumbar Interbody Fusion: A Review and Technical Note

Remarkable innovations in spinal endoscopic surgery havebroadened its applications over the past 20 years. Full-endoscopic fusions have been widely reported, and severalfull-endoscopic approaches for interbody fusion have beenpublished. In general, full-endoscopic lumbar interbodyfusion (LIF) is called Endo-LIF, and facet-preserving Endo-LIFthrough the transforaminal route is called trans-Kambin'striangle LIF, which has a relatively longer history than facet-sacrificing Endo-LIF via the posterolateral route. Both ap-proaches can reduce intraoperative and postoperativebleeding. However, there is a higher risk of subsidence andexit nerve root injury. There is no direct decompression ineither of the interbody fusions, and additional decompressionis required if there is severe lumbar bony canal stenosis.However, the posterior interlaminar approach, which is awell-known standard in full-endoscopic spine surgery, hasrarely been applied in the field of endoscopic lumbar fusionsurgery. Full-endoscopic posterior LIF (FE-PLIF) via an inter-laminar approach can accomplish direct decompression ofbony canal stenosis and safe interbody fusion. FE-PLIF via aninterlaminar approach demonstrated a longer operation time,less blood loss, and shorter hospitalization duration thanminimally invasive transforaminal LIF. FE-PLIF, which canaccomplish direct decompression for bony spinal canal ste-nosis, is superior to other Endo-LIFs. However, FE-PLIF re-quires technical dexterity to improve efficiency and reducetechnical complexity.