Application of the visual extra-endoscopic scraper in endoscopic lumbar interbody fusion: a technical note and preliminary results

The visualization operation of spine surgery is very important, especially in minimally invasive surgery. We introduce the Visual Extra-endoscopic Scraper (VES) as a substitute for traditional instruments such as the working channel, intervertebral reamer, and curette in Endo-LIF through the technical note and preliminary results. The VES, featuring a sharp lower-end opening for rotating cutting, is used under direct endoscopic visualization during intervertebral disc excision and bone graft bed preparation. We conducted a retrospective analysis of 26 patients who underwent Endo-LIF with the VES. Key parameters assessed included the time required to process the intervertebral space with the VES, overall surgical duration, visual analogue scale (VAS) pain scores for the back and legs, Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) scores at preoperative, postoperative, 6-month postoperative, and final follow-up, as well as evaluations of intervertebral fusion and associated complications. Patients treated with Endo-LIF had an average time of 17.90 ± 4.5 min for using the VES to remove intervertebral discs and prepare the bone graft bed during surgery. The total surgery time was 169.19 ± 24.90 min, with the VES accounting for 10.69 ± 2.71% of the total surgery time. Intraoperative blood loss was 50 (20, 85) ml, and the length of postoperative hospital stay was 4 (3, 7) days. Significant improvements were observed in clinical outcomes, including VAS scores for the waist and legs, ODI scores, and JOA scores at various postoperative time points compared to preoperative values ( P < 0.05). The VES in Endo-LIF surgery for treating lumbar degenerative diseases demonstrates significant value by reducing procedure time under endoscopic direct vision. It improves the efficiency of discectomy and bone graft bed preparation and reduces neuro-related complications. The study was approved by the ethics committee of the First Affiliated Hospital of Guangzhou University of Chinese Medicine (NO. JY2022-133).