Percutaneous lumbar fusion

The first successful performance of an outpatient percutaneous lumbar interbody fusion was performed in 2005 in the sate of New Jersey in the US. This medical advance had a positively transformative impact on th world of spine surgery as it provided clear evidence that a fusion of the lumbar spine could be safely and effectively carried out in a percutaneous manner.

The evolution of video-endoscopic technology that had beeb occurring in other medical specialities provided some of the conceptual considerations necessary to actually perform the procedure using a percutaneous approach.

The surgical details associated with the procedure are principally related to the use of the transforaminal approach, that had been used by interventional pain and radiology physicians, to place anti-inflammatory steroids into the neuroforaminal canal for the purposes of treating the pain associated with herniated lumbar discs.

The attached video and narrative demonstrate the sequential dilation of the muscular tissues surrounding the spinal column and the specialised intstruments that are used to initially clear the intervertebral space of degenerated disc material. The procedure was the first example of an entirely percutaneous lumbar fusion which required the liberal use of fluroscopic guidance and interpretation. The skills acquired in training and practice by the interventional and radiology physicians in the percutaneous placement of needles and probes provided them with the foundation on which the percutaneous lumbar fusion was performed in 2005.

The placement intra-operatively of a caudal steroid injection reduced the level of post operative pain to an extent which incombination with the marked reduction of blood loss and muscle damgage allowed the patient to return home within hours after the surgery.

The spine industry recognised the watershed that this case had created and began to devote more of their resources to the development of perctaneous spinal devices and instruments able to treat an ever incrasing range of conditions.

The increasing implementation of stem cell therapy is also a consequence of the refinement of the percutaneous spine surgery sector, which is predicted to grow annually by at least 10% over the next ten years. The percutaneous technology is as a consequence of its many clinical advantages being rapidly adopted by emerging economies.

Although this article and the associated video relate to a percutaneous lumbar fusion, the principles and techniques of this innovative spinal approach have been appplied to many other therapeutic surgical approaches such as lumbar facet fusion and lumbar endoscopic discectomy.

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