Microendoscopic unilateral posterior lumbar interbody
fusion (ME-PLIF) with percutaneous pedicle screw
fixation and its complications
Yuichi Takano, Satoshi Baba, Ryutaro Shiboi, Hirohiko Inanami, and*Yasushi Oshima
Dept. of Orthop. Surg., Iwai Orthopaedic Medical Hospital, Tokyo, JAPAN*Dept. of Orthop. Surg., the University of Tokyo

Now we are here!
2013PASMISS

No conflict of interest

Background
10.1%
In Japan
11154 microendoscopic spine surgeriesin 287 hospitals in 2011
(Hasegawa T. JOA incident report 2012）2013PASMISS(Takano Y., et al. JSSR 2013)

Comparison of incident rate in this study with JOA report
This study (Takano 2013)

JOA report (Hasegawa 2012)

Total (n)Rate （％）

Total (n)Rate (%)

MED

570

1.95762

2.1

MEL

206

6.3

2936

3.9

ME-PLIF

195

8.7

649

3.7

MECD

118

0.8

324

0.93

PELD

41

01302

0.31

1130

3.710973

2.39

PLIF via 18mm Tubular retractore

Percutaneus pedicle screw (PPS)2013PASMISSEvaluation chart for incident level（国立大学病院医療安全管理協議会）
Continuity
Grade of injury
of injury

Level
02

INCIDENT

13a4a4b5

ACCIDENT

3bContents－－エラーや医薬品・医療用具の不具合が見られたが、患者には実施されなかったなし－

患者への実害はなかった（何らかの影響を与えた可能性は否定できない）

Temporarymild

処置や治療は行わなかった（患者観察の強化、バイタルサインの軽度変化、安全確認のための検査などの必要性は生じた）

Temporary

Moderate

簡単な処置や治療を要した（消毒、湿布、皮膚の縫合、Hospitalization extension （－）
鎮痛剤の投与など）

Temporary

Severe

濃厚な処置や治療を要した（バイタルサインの高度変化、人工呼吸器の装着、手術、入院日数の延長、外来患者
Hospitalization extension （＋）の入院、骨折など）

Permanent

mild～
moderate

永続的な障害や後遺症が残ったが、有意な機能障害や美容上の問題は伴わない

Permanent
Death

Moderate～ 永続的な障害や後遺症が残り、有意な機能障害や美容
Severe上の問題を伴う－死亡（原疾患の自然経過によるものを除く）
2013PASMISSIncident rate of ME-PLIF inthis study(Takano Y., et al. JSSR 2013)
Total(n)(％)

Incident(n)Rate（％）

MED

570

50.5

111.9

MEL

206

18.2

136.3

ME-PLIF

195

17.3

8.7

MECD

118

10.4

171

PELD

41

3.60＊

1130

100

421

１2

3a3b２８１

１９２

１１

６0.8
0 conversion in 3
＊MED
cases
3.7
１３２８

１１０Aims• The purposes of this study were to investigate complicationsof microendoscopic ME-PLIF with PPS and to introduce
microendoscopic techniques for complication.
2013PASMISS4Materials & Methods• 195 Pts of ME-PLIF in 2011
(one-level :160 two-level :35)
• ME-PLIF procedure through 18 mm tubular retractor

Total facetectomy
Neuraldecompression

EP preparationbone graft
cage insertion

Percutaneouspedicle screw
fixation （PPS）

Microendoscopic techniques for C-shape cage insertion

Microendoscopic view

Lateral view

2013PASMISS

Typical case
68 y.o. female
Right L4/5 intraforaminal stenosis
L4 degenerative spondylolisthesis
JOA score pre 14 → post 27/29
Excellent

2013PASMISSComplications in ME-PLIF
Steep learning curve in ME-PLIF (Takano 2011)
Ope time in ME-PLIF shorten than in open PLIF (Takano 2012)

ME-PLIF 108.7 min
Blood loss 75.1ml.
Open160.7
min

3b incident in ME-PLIF 154.2 min (100-251)

3b incidents in ME-PLIF in 2011dural tears
1/12
infections
hematoma
1/1
cage deviation
2013PASMISS

3/3
1/1

3b level incidents
in ME-PLIF
3b level incident•dural tears
1/12
ME dural repair•infections
3/3
ME cage removal•hematoma
1/1
ME decompression•cage deviation 1/1
removal via anterior
approach2013PASMISS

Surgical site infection in ME-PLIFSex

PLIFlevel

1sthospitalization

Time todetection(day)

WBC

CRP

Past
history

Positiveculture

59

M

L3/4

11359300

4.12

Revision

MRSE

286M

L5/S1

47

1913350

16.45

DM
Revision

CNS

378

M

L4/5

8739560

3.27

DMCa
Agese1Time to detection of SSI fordeep infections

Incident rate (%)

Mean(days)

Median(days)

Total(%)

Deep
Infection

PLIF

Pull ter Gunne AF(Spine 2010)

29.9

15.0

4.2 %
132/3174

2.6 %84/3174

67/?

In this study

42.3

35.0

0.2%
3/11300.2%
3/1130

1.5%
3/195

2013PASMISSConclusion• ME-PLIF allows for safe and efficient minimally invasive
treatment of lumbar degenerative disorders.
• Most of the complications in ME-PLIF were treated withmicroendoscopic techniques.
• In ME-PLIF, the rate of 3b level incident was 3.0%. The evitablecomplications were present.
• The development of a new technique and a new device toprevent surgical site infection is expected in future.
2013PASMISS