Abstract

Since 2005, as we showed here, we’ve inserted percutaneous cages for lumbar arthrodesis in “virgin spines” and in previously operated spines. Most of the first patients have been operated on in prone position. In the case of treating one disc by using an arthrodesis and one hernia on the level above on the same side in lateral position, we began to carry out the arthrodesis on only one side. Seeing that the results on virgin spines were encouraging, 29 good primary results with a mean follow-up of 2 years on 39 patients, we wanted to simplify the technique by making a lateral approach and by using a more simple technique. In the case of one patient we put in two cages on the same side at every level, on L2L3 and L3L4 in the middle of the intervertebral space. For one other patient, we put in two cages in L3L4 through the same side. In the cases of three patients, we made a unilateral approach on L4L5 and put in two cages for two patients and one cage for the last patient. For one other patient, we put in two cages in L5S1. The immediate results were good. We can’t exactly explain why we can put in two cages for some patients and only one for others, particularly on the L4L5 level. Could this be due to the width of the Kambin triangle or to the number and the position of anastomosis between the exiting root and the white or grey ramus communicans of the sympathetic system which carries the nociceptive fibers? If the exiting root is painful while passing the dilators, we have a look at the endoscopic view of it and try to push it away without any pain. Then we pass the cage preceded by the dilators. As a conclusion, we will show each case in detail and discuss the future of this technique.