Chapter 29 Percutaneous Transforaminal Lumbar Interbody Stabilization
Percutaneous endoscopic transforaminal discectomy has been an effective alternative to microdiscectomy for patients with soft lumbar disc herniations [1–5]. However, it is ineffective in the presence of lumbar segmental instability due to degenerative disc disease. Percutaneous transforaminal lumbar interbody stabilization (PTLIS) is a new surgical method for treating lumbar segmental instability due to degenerative disc disease and low-grade degenerative spondylolisthesis.
The specially designed B-Twin expandable holder (Disc-O-Tech Medical Technologies Ltd., Herzliya, Israel), which is made of titanium, is used as an interbody spacer to achieve stability without open discectomy and fusion [6–11]. In cases of failure, this minimally invasive procedure does not impede conventional surgical approaches.
Instrumentation
Prior to surgery, the required implant diameter is determined through the use of lateral and anteroposterior radiographs and computed tomography or magnetic resonance imaging. The intervertebral space is measured, and 10% to 20% is added to determine the appropriate expanded diameter of the device (Table 29.1). This diameter determines the implant to be selected.
The length of the intervertebral space (the anteroposterior borders of the vertebral body) should be at least 28 mm for the use of the trapezoid implants. Verification of implant diameter and length is also performed during surgery, as detailed in the later Figures 29-1 to 29-8