Spinal Endoscopy for Decompression Combined with Lateral Lumbar Interbody Fusion

ანოტაცია

Lateral procedures are becoming more popular in the treatment of lumbar degenerative disease because of the decreased soft tissue disruption, morbidity and recovery times as compared to open surgery. Lateral lumbar interbody fusion (LLIF) and oblique lumbar interbody fusion (OLIF) are effective indirect decompression techniques, but with severe stenosis and approach-specific limitations, there may be continued neural compression that necessitates adjunctive endoscopic decompression. The purpose of this narrative review was to provide an overview about the clinical rationale, current applications, limitations, and future directions of the combination of endoscopic neural decompression and LLIF/OLIF. A systematic review was conducted in PubMed/MEDLINE, Embase, Scopus, Web of Science, Cochrane Library and Google Scholar databases from the year 2016 to 2026. The literature was reviewed to perform a comprehensive analysis of the efficacy and complications of combined LLIF and combined OLIF in adult clinical use, indications, and available evidence. There are studies available indicating that adjunctive endoscopic decompression of any residual compression – either central or foraminal – can be helpful that may not be sufficiently corrected by indirect decompression alone. These reported advantages are reduction in pain, improvement in functional outcomes, improvement in radiological parameters and preservation of paraspinal musculature. But there are some methodological flaws that limit the current evidence; for example, few studies have been conducted on small populations, with varying methods, and designs that are retrospective, and there is no randomized controlled study that compares combined procedures with usual surgical alternatives. Patient selection is important, especially for patients with serious stenosis who may not benefit from indirect decompression. In summary, combined endoscopic decompression via LLIF/OLIF is a promising MIS approach in the carefully selected patient with LDH. Continued prospective multicenter studies with consistent outcomes, longer follow-up, cost-effectiveness analyses and evaluation of learning curves should be performed to define long-term safety, durability and best indications.