scholarly journals Unilateral biportal endoscopic decompression by 30° endoscopy in lumbar spinal stenosis: Technical note and preliminary report

2018 ◽  
Vol 15 (2) ◽  
pp. 366-371 ◽  
Author(s):  
Ju-Eun Kim ◽  
Dae-Jung Choi
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Preliminary Report ◽  
Technical Note ◽  
Endoscopic Decompression ◽  
Lumbar Spinal

scholarly journals Percutaneous biportal endoscopic decompression for lumbar spinal stenosis: a technical note and preliminary clinical results

2016 ◽  
Vol 24 (4) ◽  
pp. 602-607 ◽  
Author(s):  
Jin Hwa Eum ◽  
Dong Hwa Heo ◽  
Sang Kyu Son ◽  
Choon Keun Park
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Excellent Result ◽  
Technical Note ◽  
Decompression Surgery ◽  
Lumbar Stenosis ◽  
Continuous Irrigation ◽  
Endoscopic Decompression ◽  
Alternative Treatment Option ◽  
Lumbar Spinal

OBJECTIVE The use of conventional uniportal spinal endoscopic decompression surgery for lumbar spinal stenosis can be limited by technical difficulties and a restricted field of vision. The purpose of this study is to describe the technique for percutaneous biportal endoscopic decompression (PBED) for lumbar spinal stenosis and analysis of clinical postoperative results. METHODS The authors performed a unilateral laminotomy with bilateral foraminal decompression using a unilateral biportal endoscopic system in patients with single-level lumbar stenosis. The authors enrolled only patients who underwent follow-up for longer than 12 months after PBED. Fifty-eight patients were enrolled in this study. This approach was based on 2 portals: one portal was used for continuous irrigation and endoscopic viewing and the other portal was used to manipulate the instruments used in the decompression procedures. Clinical parameters such as the Oswestry Disability Index (ODI), Macnab criteria, and postoperative complications were analyzed. RESULTS Neural decompression was effectively performed in all enrolled patients. The mean ODI was significantly lower after PBED. Of 58 patients, 47 (81.0%) had a good or excellent result according to the Macnab criteria. Postoperative ODI and visual analog scale scores were significantly improved compared with preoperative values. CONCLUSIONS From a surgical point of view, percutaneous biportal endoscopy is very similar to microscopic spinal surgery, permitting good visualization of the contralateral sublaminar and medial foraminal areas. The authors suggest that the PBED, which is a minimally invasive procedure, is an alternative treatment option for degenerative lumbar stenosis.

scholarly journals Radiographic outcomes of endoscopic decompression for lumbar spinal stenosis

2019 ◽  
Vol 46 (5) ◽  
pp. E10 ◽  
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.

scholarly journals Therapeutic Effect of Large Channel Endoscopic Decompression in Lumbar Spinal Stenosis

2021 ◽  
Vol 8 ◽  
Author(s):  
Fei-Long Wei ◽  
Ming-Rui Du ◽  
Tian Li ◽  
Kai-Long Zhu ◽  
Yi-Li Zhu ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Physical Component Summary ◽  
Japanese Orthopaedic Association ◽  
Intraoperative Complication ◽  
Endoscopic Decompression ◽  
Estimated Blood Loss ◽  
Sf 36 ◽  
Large Channel ◽  
Lumbar Spinal

Background: Percutaneous endoscopic decompression (PED) is a minimally invasive surgical technique that is now used for not only disc herniation but also lumbar spinal stenosis (LSS). However, few studies have reported endoscopic surgery for LSS. Therefore, we conducted this study to evaluate the outcomes and safety of large channel endoscopic decompression.Methods: Forty-one patients diagnosed with LSS who underwent PED surgery were included in the study. The estimated blood loss, operative time, length of hospital stay, hospital costs, reoperations, complications, visual analogue scale (VAS) score, Oswestry Disability Index (ODI) score, Japanese Orthopaedic Association (JOA) score and SF-36 physical-component summary scores were assessed. Preoperative and postoperative continuous data were compared through paired-samples t-tests. The significance level for all analyses was defined as p &lt; 0.05.Results: A total of 41 consecutive patients underwent PED, including 21 (51.2%) males and 20 (48.8%) females. The VAS and ODI scores decreased from preoperatively to postoperatively, but the JOA and SF-36 physical component summary scores significantly increased. The VAS (lumbar) score decreased from 5.05 ± 2.33 to 0.45 ± 0.71 (P = 0.000); the VAS (leg) score decreased from 5.51 ± 2.82 to 0.53 ± 0.72 (P = 0.000); the ODI score decreased from 52.80 ± 20.41 to 4.84 ± 3.98 (P = 0.000), and the JOA score increased from 11.73 ± 4.99 to 25.32 ± 2.12 (P = 0.000). Only 1 patient experienced an intraoperative complication (2.4%; dural tear), and 1 patient required reoperation (2.4%).Conclusions: Surgical treatment for LSS is to sufficiently decompress and minimize the trauma and complications caused by surgery. This study did not reveal any obvious shortcomings of PED and suggested PED is a safe and effective treatment for LSS.

scholarly journals Degenerative central lumbar spinal stenosis: Is endoscopic decompression through bilateral transforaminal approach sufficient?

2020 ◽  
Author(s):  
Bin Zhang ◽  
Qingquan Kong ◽  
Yuqing Yan ◽  
Pin Feng
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Operation Time ◽  
Decompression Surgery ◽  
Cross Sectional ◽  
Endoscopic Decompression ◽  
Dural Sac ◽  
Transforaminal Approach ◽  
The Mean ◽  
Lumbar Spinal

Abstract Background: At present, few percutaneous endoscopic transforaminal decompression surgery has been reported to solve central lumbar spinal stenosis (CLSS). Whether endoscopic decompression through lateral transforaminal approach decompression is sufficient for degenerative CLSS.Methods: This retrospective study included 47 cases of CLSS patients who underwent percutaneous endoscopic decompression through a bilateral transforaminal approach. Clinical outcomes such as ODI, back and leg VAS, the Macnab criteria were evaluated. Surgical results including operative time, postoperative hospital stay, recurrence, and surgical complications were also studied. Radiologically, lumbar stability was assessed and lumbar dural sac dimension was compared preoperatively and postoperatively.Results：All 47 patients were followed up. The average follow-up period was 24.5 months. The average operation time was 116 minutes. The mean VAS of leg and back pain, and the mean ODI improved from 7.81, 2.53, and 77.03% at baseline to a final 1.94 (P=0.00), 2.47 (P=0.71), and 19.40 % (P=0.00), respectively. According to the Macnab criteria, 97.9% of patients achieved excellent and good results. There were 2 cases of dura tear and 3 cases of transient postoperative dysthesia. The cross sectional area of the dural sac was significantly enlargement at the last fellow up (74.28±13.08 mm2 vs.104.91±12.40 mm2, P=0.00).Conclusions: Except for the main pathogenic factors on the dorsal side of the dural sac, percutaneous endoscopic decompression through a bilateral transforaminal approach is sufficient for CLSS. It is a feasible, safe, and clinically effective minimally invasive procedure.

Internal Decompression for Multiple Levels of Lumbar Spinal Stenosis: A Technical Note

Neurosurgery ◽  
1982 ◽  
Vol 11 (4) ◽  
pp. 546-549 ◽  
Author(s):  
Paul M. Lin
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Spinal Canal ◽  
Posterior Lumbar Interbody Fusion ◽  
Pain Syndrome ◽  
Technical Note ◽  
Canal Stenosis ◽  
Spinous Processes ◽  
Multiple Levels ◽  
Lumbar Spinal

Abstract In cases of lumbar spinal stenosis, use of the wide decompressive procedure for neural compression without regard for the integrity of facets tends to lead to instability and the chronic pain syndrome. Experience with the posterior lumbar interbody fusion technique indicates that, in cases of multiple levels of spinal canal stenosis, the decompression can be made adequately by inferior and superior marginal laminotomy, mesial facetectomy with an osteotome, and foraminotomy with an angle bone punch and a supersonic curette. Internal thinning of the thickened lamina can be achieved by the shaving action of the supersonic curette done from within the spinal canal. This technique achieves the necessary internal decompression of the multiple levels of spinal stenosis without interruption of the integrity of the motion segment. The spinous processes and the supraspinous ligaments and the lateral half of the facet, with its firm fibrous capsules, are scrupulously preserved. The disc is not removed unless it is overtly extruded.

Transforaminal Endoscopic Decompression for Lumbar Spinal Stenosis: A Novel Surgical Technique and Clinical Outcomes

2018 ◽  
Vol 114 ◽  
pp. e873-e882 ◽  
Author(s):  
Sang-Ha Shin ◽  
Jun-Seok Bae ◽  
Sang-Ho Lee ◽  
Han-Joong Keum ◽  
Ho-Jin Kim ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Clinical Outcomes ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Endoscopic Decompression ◽  
Lumbar Spinal
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