Percutaneous Full Endoscopic Bilateral Lumbar Decompression of Spinal Stenosis Through Uniportal-Contralateral Approach: Techniques and Preliminary Results

Abstract BACKGROUND Endoscopic spine surgery is an alternative to the traditional treatment of lumbar disc herniation. However, the traditional technique of interlaminar endoscopic approach is challenging and risky in patients with concomitant spinal stenosis. OBJECTIVE To report a modified technique called hybrid interlaminar endoscopic lumbar decompression as an effective treatment. METHODS Patients with combined lumbar disc herniation and lateral recess stenosis undergoing full-endoscopic interlaminar lumbar discectomy were retrospectively studied. The hybrid interlaminar endoscopic discectomy technique, as well as the use of 2 endoscopes with different diameters, is described in detail. The large endoscope is used for the laminotomy procedure, while the small endoscope is used for the discectomy procedure. The demographics and clinical outcomes of the patients are presented. RESULTS A total of 19 patients were included in this study. The mean age was 46.7 yr. The visual analog scale for back and leg pain improved from 5.6 ± 3.4 and 7.5 ± 2.3 to 1.8 ± 1.3 and 1.8 ± 1.6, respectively (P < .001). The mean Oswestry Disability Index improved from 59.9 ± 21.2 preoperatively to 18.2 ± 8.5 postoperatively (P < .001). The follow-up was 8.2 mo on average. No major complications occurred, but 2 patients reported mild postoperative paresthesia. One patient had an early recurrence and underwent repeat endoscopic discectomy. CONCLUSION Full-endoscopic lumbar discectomy provides excellent access to the intracanalicular herniation site of an intervertebral disc. By using the endoscopic technique presented here, surgeons can safely and efficiently achieve adequate decompression in patients with lumbar disc herniation combined with spinal stenosis.

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Poster 126 Lumbar Spinal Stenosis Treatment With an Interspinous Spacer: Preliminary Results of a Multicenter, Randomized, Controlled FDA-IDE Trial

PM&R ◽

10.1016/j.pmrj.2011.08.160 ◽

2011 ◽

Vol 3 ◽

pp. S213-S213 ◽

Cited By ~ 1

Author(s):

William G. Cano ◽

Jon E. Block ◽

Thomas Haley ◽

Sagi Kuznits ◽

Larry E. Miller

Keyword(s):

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Preliminary Results ◽

Interspinous Spacer ◽

Randomized Controlled ◽

Lumbar Spinal

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Surgical treatment of lumbar spinal stenosis in patients older than 75 years of age

Journal of Neurosurgery Spine ◽

10.3171/spi.1999.91.2.0181 ◽

1999 ◽

Vol 91 (2) ◽

pp. 181-185 ◽

Cited By ~ 14

Author(s):

Todd W. Vitaz ◽

George H. Raque ◽

Christopher B. Shields ◽

Steven D. Glassman

Keyword(s):

Surgical Treatment ◽

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Intraoperative Complication ◽

Content Type ◽

Fusion Procedure ◽

Lumbar Decompression ◽

Preoperative Selection ◽

Lumbar Spinal ◽

Fine Print

Object. The purpose of this study was to evaluate the safety and efficacy of the surgical treatment of lumbar spinal stenosis in patients older than 75 years of age. Methods. The authors reviewed the records of 65 patients with lumbar spinal stenosis who were at least 75 years of age at the time of surgery, which was performed between November 1990 and May 1996. The 65 patients (43 women, 22 men; average age 78 years) underwent a total of 71 operations (one patient underwent three, and four patients underwent two). Fifteen patients (21%) underwent isolated lumbar decompression, and 56 patients (79%) underwent decompression in conjunction with posterior spinal fusion. There was an average of 1.7 levels decompressed per isolated lumbar decompression and 2.6 levels per decompression and fusion procedure. Seven patients (10%) experienced one or more serious postoperative complication, which included wound infection, septicemia, small bowel obstruction, stroke, myocardial infarction, gastrointestinal bleeding, and pulmonary embolus. In addition there was one intraoperative complication (hypotension [1%]) that required modification of the planned surgical procedure. No deaths were documented in the perioperative period. Conclusions. With appropriate preoperative selection and evaluation, careful intraoperative monitoring, and attentive perioperative care, the surgical treatment of elderly patients with lumbar spinal stenosis can effect significant improvement with acceptable levels of morbidity and mortality.

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mild® Lumbar Decompression for the Treatment of Lumbar Spinal Stenosis

The Neuroradiology Journal ◽

10.1177/197140091102400419 ◽

2011 ◽

Vol 24 (4) ◽

pp. 620-626 ◽

Cited By ~ 13

Author(s):

D.F. Schomer ◽

D. Solsberg ◽

W. Wong ◽

B.W. Chopko

Keyword(s):

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Lumbar Decompression ◽

Lumbar Spinal

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Study of Percutaneous Lumbar Decompression and Treatment Algorithm for Patients Suffering from Neurogenic Claudication

January 2018 - Pain Physician ◽

10.36076/ppj.2012/15/451 ◽

2012 ◽

Vol 6;15 (6;12) ◽

pp. 451-460

Author(s):

Timothy R. Deer

Keyword(s):

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Radicular Pain ◽

Neurogenic Claudication ◽

Lumbar Decompression ◽

Reduction Of Pain ◽

One Year ◽

Lumbar Spinal ◽

Over Time

Background: Symptomatic lumbar spinal stenosis (LSS) patients often suffer from multiple etiologies, and patient symptoms must be differentiated and identified as either neurogenic claudication, radicular pain, or both. The most common symptom associated with LSS is neurogenic claudication, which has been reported to occur in 91% to 100% of the LSS patient population. Neurogenic claudication symptoms are described as pain radiating to the lower extremities that begins and worsens as the patient ambulates. Neurogenic claudication symptoms worsen over time and can eventually result in significant life-altering functional limitations. Symptomatic LSS patients may also suffer from radicular pain, which is a persistent pain transmitted through neural pathways, and is associated with inflammation of the exiting nerve root. Objective: To assess patient safety, pain reduction, and functional status of patients treated with percutaneous lumbar decompression. Study Design: Single-center, prospective clinical study of 46 consecutive patients with neurogenic claudication symptoms related to lumbar spinal stenosis. Setting: US interventional pain management practice. Methods: From March 2010 to January 2011, 46 LSS patients suffering from neurogenic claudication underwent mild percutaneous lumbar decompression. Of these, 12-week, 6-month and one-year followup was available for 35 patients. Outcome Assessment: Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and Zurich Claudication Questionnaire (ZCQ). Outcomes were assessed at baseline, 12-week, 6-month and one-year follow-up. Results: One-year follow-up patients in this study experienced statistically and clinically significant improvement in physical function, as well as reduction of pain intensity. The initial improvement in these patients, which was significant, was sustained through one year, with no significant differences among the interim follow-up visit periods. These results demonstrate early improvement following treatment with a high degree of durability over time. There were no serious device or procedure-related complications reported in this study. Limitations: Single-center study with no control group. Conclusions: In this study, the mild procedure was shown to be safe. In addition, patients experienced significant improvement in mobility and reduction of pain one year after the procedure. One-year outcomes were not significantly different from interim results, indicating that the significant improvement following treatment, occurring as early as 12 weeks, was maintained through one year. This high degree of consistency over time indicates the durability of percutaneous lumbar decompression in the treatment of neurogenic claudication in symptomatic LSS. Key words: Spine, lumbar, lumbar spinal stenosis, neurogenic claudication, decompression, ligamentum flavum, mild, percutaneous.

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