A great video by Dr Christian Morgenstern, MD, PhD, MSc.
You can watch the video here
This is a 73 years old female who suffered from severe low back pain, bilateral radiating leg pain and neurogenic claudication. She presented a surgical history of laparotomy due to ectopic pregnancy with several revision surgeries with abdominal mesh, that advised against anterior / ALIF surgery. She also had a sacral neuromodulator due to urinary incontinence that contraindicated the use of monopolar cautery.
In pre-operative imaging she suffered from a degenerated lumbar scoliosis, a degenerative spondylolisthesis at L4/L5, vacuum sign and Modic II changes at L3/L4 and L5/S1 with severe bilateral foraminal and central canal stenosis.
She underwent “several” surgeries in the same day:
– a 2-level anterior-to-psoas / OLIF for L3/L4 and L4/L5
– an endoscopic trans-Kambin fusion at L5/S1 using the Maxfusion system from MaxMoreSpine with the Vertaconnect large-footprint interbody cage from SIGNUS – The Spine Sign
– posterior augmented fixation from L3 to S1
– endoscopic uniportal bilateral decompression of L5/S1
She was able to ambulate pain-free 12 hours after surgery and was discharged from the hospital 24 hours after surgery. No opioid medication was administered peri- and post-operatively.
The MaxFusion system allows placement of large-footprint interbody cages through Kambin’s triangle as it does not use as tube or working channel with a specific diameter that limits the size of an interbody cage.