scholarly journals Trans-foraminal endoscopic uniportal decompression in degenerative lumbar spondylolisthesis: a technical and case report

2019 ◽  
Vol 34 (1) ◽  
Author(s):  
Ajay Krishnan ◽  
Mahesh Kulkarni ◽  
Mreetaunjay Singh ◽  
Chaitanya Reddy ◽  
Shivanand Mayi ◽  
...  
Keyword(s):  
Case Report ◽  
Spinal Fusion ◽  
Lumbar Disc ◽  
Degenerative Spondylolisthesis ◽  
Lateral Recess ◽  
Excellent Outcome ◽  
Lateral Recess Stenosis ◽  
Select Group ◽  
Degenerative Lumbar Spondylolisthesis ◽  
Endoscopic Lumbar Discectomy

Abstract Background Degenerative spondylolisthesis is a common spinal pathology. Traditionally, spinal fusion is an accepted standard surgical treatment for listhesis. But fusion is a major intervention with its known pitfalls. With technological progression, minimally invasive spinal fusion (MISF) procedures are becoming mainstream. Percutaneous trans-foraminal endoscopic lumbar discectomy/decompressions (PTELD) without stabilization has many advantages over even a MISF for select group of patients. Case presentation In this case report, we describe using a uniportal unilateral trans-foraminal approach (TFA) for stable listhesis with lumbar disc herniation (LDH) causing chronic bilateral radicular symptoms and back pain with acute exacerbation. Under local anesthesia, we used a flat entry for PTELD, which facilitates an approach to both disc sides ventrally and even dorsal aspect lateral recess decompression on the dominant ipsilateral side. No fixation was done. An excellent outcome is obtained immediately at 6 weeks and maintained at 39 months of follow-up. Conclusion PTELD is worth considering as an intermediate procedure before fusion is offered in lateral recess stenosis in stable listhesis patients who have consented and understand the progressive cascade of spinal degeneration.

scholarly journals Foraminoplasty at the Tip or Base of the Superior Articular Process for Lateral Recess Stenosis in Percutaneous Endoscopic Lumbar Discectomy: A Multicenter, Retrospective, Controlled Study with 2-Year Follow-Up

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Jun-Song Yang ◽  
Lei Chu ◽  
Chien-Min Chen ◽  
Xiang-Fu Wang ◽  
Pei-Gen Xie ◽  
...  
Keyword(s):  
Clinical Efficacy ◽  
Lumbar Discectomy ◽  
Lateral Recess ◽  
Articular Process ◽  
Lateral Recess Stenosis ◽  
Sf 36 ◽  
Group A ◽  
Group B ◽  
Endoscopic Lumbar Discectomy

Objective. To compare the clinical efficacy and complications which obtained foraminoplasty at the tip or base of the superior articular process (SAP) for the patients with lateral recess stenosis treated by percutaneous endoscopic lumbar discectomy (PELD). Methods. Between January 2015 and January 2016, 156 patients of lumbar disc herniation accompanying with lateral recess stenosis were treated with PELD in five tertiary hospitals and fulfilled the 2-year follow-up. Among them, 78 patients obtained a foraminoplasty at the tip of SAP (group A), and foraminoplasty at the base of SAP was performed in the other 78 cases (group B). Clinical efficacy was evaluated using the visual analog scale (VAS) score for back and leg pain, Oswestry Disability Index (ODI), and 36-item Short-Form Health Survey (SF-36) score. The intervals of follow-up were scheduled at 1 month, 3 months, 6 months, 1 year, and 2 years after surgery. Results. Mean operative duration is shorter in group B (55 versus 61 min, P = 0.047). Only one case belonged to group A could not tolerate the neural irritation and required conversion to an open procedure. During the surgery, no dura tears, cauda equina syndrome, or infections were observed. 5 patients experienced transient dysesthesia located at the exiting nerve in group A, while no cases complained dysesthesia in group B. 2 cases who suffered temporary motor weakness all belonged to group A. A total of 5 cases obtained a revision surgery after recurrence in the follow-up, in which 3 patients belonged to group A. Compared to the preoperative data, significant improvements in VAS scores of low back pain and sciatica, ODI, and SF-36 PCS and MC were observed in the follow-up, respectively (P < 0.05, respectively). However, no statistical difference was observed at all time-points after surgery between these two groups (P > 0.05, respectively). Conclusions. For the patients of LDH accompanying with lateral recess stenosis, compared with the routine foraminoplasty at the tip of SAP, our modified foraminoplastic technique does not only change place of foraminoplasty to the base of SAP but also simplified puncture process in transforaminal PELD. Although there was no significant difference in symptom relief, the modified foraminoplasty showed the advantages in decreasing the incidence of postoperative neural dysfunction and reducing operation time.

scholarly journals Open Lumbar Microdiscectomy and Posterolateral Endoscopic Lumbar Discectomy for Antero- and Retrospondylolisthesis

2020 ◽  
Vol 4;23 (7;4) ◽  
pp. 393-403
Author(s):  
Dong-Ju Yun
Keyword(s):  
Disc Degeneration ◽  
Telephone Survey ◽  
Lumbar Disc ◽  
Degenerative Spondylolisthesis ◽  
Lumbar Discectomy ◽  
Telephone Surveys ◽  
Percutaneous Endoscopic Lumbar Discectomy ◽  
Lumbar Microdiscectomy ◽  
Herniated Lumbar Disc ◽  
Endoscopic Lumbar Discectomy

Background: Posterolateral endoscopic lumbar discectomy (PLELD) or percutaneous endoscopic lumbar discectomy has been reported to be effective as treatment for herniated lumbar disc in degenerative spondylolisthesis. Few studies have investigated the outcomes of open lumbar microdiscectomy (OLM) and PLELD for antero- and retrospondylolisthesis with mild slippage and instability. Objectives: We aimed to evaluate the outcomes of OLM and PLELD for antero- and retrospondylolisthesis with mild slippage and instability. Study Design: This study used a retrospective design. Setting: Research was conducted in a hospital and outpatient surgical center. Methods: This study enrolled 84 patients aged 20 to 60 years with low-grade degenerative spondylolisthesis who underwent OLM or PLELD for antero- or retrospondylolisthesis at our hospital between March 2007 and August 2014 and who were followed up for at least 3 years. Telephone survey and chart review, with a particular focus on pre- and postoperative radiographic parameters, were conducted. Additionally, patients were invited to undergo reexamination to update their clinical and radiological data. Results: Telephone surveys and clinical/imaging evaluation were conducted on the OLM and PLELD groups at a mean of 71.44 and 74.69 months, respectively. Out of 43 patients who underwent OLM, 34 responded to the telephone survey, 17 of whom then underwent reexamination. Among 41 patients who underwent PLELD, 32 responded to the telephone survey, 19 of whom then underwent reexamination. Based on telephone surveys and patient charts, reoperation at the same vertebral level was confirmed in 8 patients (23.5%) who underwent OLM and one patient (4.4%) who underwent PLELD, with a significantly higher rate of reoperation in the OLM group (P = .028). Vertebral disc height decreased more after OLM than after PLELD. Compared to PLELD, OLM was associated with significantly worse rates of iatrogenic endplate damage, endplate defect scores, and alterations in subchondral bone signal intensity. However, the final clinical outcomes did not differ between OLM and PLELD. Limitations: The limitations of this study include its relatively small sample size and the possibility of bias owing to nonrandomized patient selection. Conclusions: In patients with spondylolisthesis who have a herniated lumbar disc as mild slippage with instability, PLELD may be a good treatment option to reduce recurrence rates and mitigate disc degeneration. IRB approval number: 2016-12-WSH-011 Key words: Anterospondylolisthesis, disc degeneration, endplate, herniated lumbar disc, open lumbar discectomy, percutaneous endoscopic lumbar discectomy, posterolateral endoscopic lumbar discectomy, retrospondylolisthesis, slippage

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