Percutaneous transforaminal endoscopic decompression for lumbar spinal stenosis with degenerative spondylolisthesis in the elderly

IntroductionLumbar spinal stenosis (LSS) is a common lumbar degenerative disease in the elderly, usually requiring surgery if conservative treatment fails. Microscopic decompressive laminectomy (MDL) and percutaneous endoscopic decompressive laminectomy (PEDL) have been widely used to treat LSS. This study aims to provide a protocol for the evaluation and comparison of the efficacy, safety and applicability between MDL and PEDL.Methods and analysisWe will search for randomised controlled trials (RCTs) comparing MDL and PEDL for treating LSS from inception to December 2019 in the following databases: PubMed, The Cochrane Library, Web of Science, Embase and China Biology Medicine. The quality of included studies will be assessed using the risk of bias tool recommended by the Cochrane Handbook 5.2.0. Subsequently, a meta-analysis will be performed using RevMan 5.3 software.Ethics and disseminationGiven the nature of this study, no ethical approval will be required. The protocol will be disseminated via a peer-reviewed journal.PROSPERO registration numberCRD42020164765.

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Lumbar Spinal Stenosis and Degenerative Spondylolisthesis

Clinical Spine Surgery ◽

10.1097/bsd.0000000000000841 ◽

2019 ◽

Vol 32 (7) ◽

pp. 272-278 ◽

Cited By ~ 2

Author(s):

Haariss Ilyas ◽

Inyang Udo-Inyang ◽

Jason Savage

Keyword(s):

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Degenerative Spondylolisthesis ◽

Lumbar Spinal

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Potential pathological mechanisms of L3 degenerative spondylolisthesis in lumbar spinal stenosis patients: A case–control study

Journal of Orthopaedic Science ◽

10.1016/j.jos.2018.12.002 ◽

2019 ◽

Vol 24 (4) ◽

pp. 596-600

Author(s):

Masayoshi Fukushima ◽

Yasushi Oshima ◽

Hiroyuki Oka ◽

Chang Chang ◽

Yoshitaka Matsubayashi ◽

...

Keyword(s):

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Case Control Study ◽

Degenerative Spondylolisthesis ◽

Case Control ◽

Lumbar Spinal ◽

Control Study

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Radiographic outcomes of endoscopic decompression for lumbar spinal stenosis

Neurosurgical FOCUS ◽

10.3171/2019.2.focus18617 ◽

2019 ◽

Vol 46 (5) ◽

pp. E10 ◽

Cited By ~ 1

Author(s):

Siri Sahib Khalsa ◽

Hyeun Sung Kim ◽

Ravindra Singh ◽

Osama Nezar Kashlan

Keyword(s):

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Facet Joint ◽

Volumetric Analysis ◽

Facet Joints ◽

Bone Removal ◽

Endoscopic Decompression ◽

Radiographic Outcomes ◽

Lateral Recess Stenosis ◽

Lumbar Spinal

OBJECTIVELumbar central stenosis can theoretically be decompressed with minimal bone removal via an endoscopic approach. Although multiple studies have demonstrated an adequate radiographic decompression, none has quantified the volume of bone removal after endoscopic decompression. The objective of this study was to quantify the 3D volume of bone removed from the lamina and facet joints during endoscopic decompression for lumbar central and lateral recess stenosis.METHODSThis retrospective study included adults with lumbar spinal stenosis who underwent endoscopic decompression of a single level or 2 noncontiguous lumbar levels. Central stenosis on MRI was graded preoperatively and postoperatively using the Schizas scale. A computer program was developed in MATLAB to semiautomatically perform a 3D volumetric analysis of preoperative and postoperative lumbar CT scans. The volumetric percentage of bone removed from the lamina and facet joints ipsilateral and contralateral to the side of approach was quantified.RESULTSNineteen patients with 21 treated lumbar levels were included in the study. Preoperatively, the number of levels with Schizas stenosis grades B, C, and D were 5, 12, and 4, respectively. Stenosis grades improved postoperatively to grades A, B, C, and D for 17, 3, 1, and 0 levels, respectively. All levels improved by at least 1 stenosis grade. The volumetric percentage of laminar bone removed was 15.5% (95% CI 11.2%–19.8%, p < 0.001) from the ipsilateral lamina and 8.8% (95% CI 5.7%–11.8%, p < 0.001) from the contralateral lamina. The percentage of facet joint resection was 5.3% (95% CI 4.2%–6.4%, p < 0.001) and 4.3% (95% CI 2.2%–6.4%, p < 0.001) for the ipsilateral and contralateral facet joints, respectively. Average pain scores, as measured by the visual analog scale, improved from 7.9 preoperatively to 2.2 by 3–10 months postoperatively (p < 0.001).CONCLUSIONSEndoscopic lumbar decompression achieves improvement in the radiographic grade of lumbar central stenosis with minimal bone removal from the lamina and facet joints. Future prospective studies are needed to validate the findings of this study with more comprehensive clinical outcomes.

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