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 Percutaneous Transforaminal Endoscopic Decompression for Lumbar Lateral Recess Stenosis

2021 ◽  
Vol 8 ◽  
Author(s):  
Hui-gen Lu ◽  
Xue-kang Pan ◽  
Min-jie Hu ◽  
Jian-qiao Zhang ◽  
Jian-ming Sheng ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Disc Herniation ◽  
Treatment Effectiveness ◽  
Facet Joint ◽  
Intervertebral Disc Herniation ◽  
Endoscopic Decompression ◽  
Transforaminal Approach ◽  
Lateral Recess Stenosis ◽  
Lumbar Spinal

Objective: The aim of this study was to evaluate the treatment efficacy of lateral spinal stenosis through the decompression of the nerve root under a multiple planar endoscope.Methods: From January 2017 to March 2019, 52 patients with lumbar spinal stenosis or lumbar spinal stenosis combined with intervertebral disc herniation had been treated via transforaminal approach spinal endoscopy. Our study retrospectively analyzed the treatment outcome. All patients experienced complications with different degrees of facet joint hyperplasia and ligamentum flavum hyperplasia and hypertrophy. Some patients suffered disc herniation. All patients were treated with percutaneous transforaminal approach multiple planar endoscopic decompression. The visual analog scale (VAS) and the Oswestry Disability Index (ODI) were compared before and after the operation, as were the horizontal foramen areas of the medial margins of the upper and lower pedicles of the vertebral arch. The treatment effectiveness was evaluated.Results: VAS and ODI scores were significantly improved at postoperative 3 days, 3 months, 6 months, and the last follow-up (P &lt; 0.05). The area of the intervertebral foramen was 422.5 ± 159.2 mm2 preoperatively and 890.8 ± 367.7 mm2 postoperatively, the difference was statistically significant (P &lt; 0.05).Conclusion: Percutaneous transforaminal approach multiple planar endoscopic decompression could achieve an accurate and effective decompression of the lumbar lateral spinal canal. This procedure has good short-term effects, and is especially suitable for elderly patients.

Facet-Sparing Decompression of Lumbar Spinal Stenosis: The Minimally Invasive Bilateral Crossover Approach

2021 ◽  
Author(s):  
Jan Helge Klingler ◽  
Ulrich Hubbe ◽  
Christoph Scholz ◽  
Marie T. Krüger
Keyword(s):  
Minimally Invasive ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Case Series ◽  
Surgical Decompression ◽  
Walking Distance ◽  
Adjacent Segment ◽  
Facet Joints ◽  
Study Objective ◽  
Lumbar Spinal

Abstract Background and Study Objective One risk of established decompression techniques for lumbar spinal stenosis is the resection of facet joints, especially if they are steeply configured, promoting destabilization. Minimally invasive bilateral crossover decompression aims to preserve the facet joints and thus stability of the spine. The purpose of this study is to demonstrate the feasibility and early results of this technique. Methods This retrospective case series includes 10 consecutive patients with lumbar stenosis and steep-angle (<35 degrees) facet joints who were treated with minimally invasive bilateral crossover decompression. Eleven segments were decompressed, most commonly L3/L4 (63.6%), followed by L1/L2 and L2/L3 (18.2% each). The effectiveness of surgical decompression was assessed by self-reporting questionnaires. Results After a follow-up of 10.5 months, the Symptom Severity Scale and Physical Function Scale of the Swiss Spinal Stenosis Questionnaire improved by 0.9 (p < 0.05) and 0.7 points, respectively. The mean Oswestry Disability Index improved from 53.9 to 34.6 (p < 0.05). Local and radiating pain under strain showed statistically significant improvement on the Visual Analog Scale (8.9 vs. 5.0 and 8.4 vs. 4.6, respectively). Maximum walking distance increased from 190 to 1,029 m. Apart from one patient requiring surgical decompression of an adjacent segment, there were no reoperations, neurological deteriorations, or other complications. Conclusion The results of this study indicate that minimally invasive bilateral crossover decompression is a promising technique for the treatment of spinal canal stenosis. With its design to spare facet joints, it can potentially reduce the risk of spinal instability, especially in patients with steep facet joints.

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 Characterization of subchondral bone histopathology of facet joint osteoarthritis in lumbar spinal stenosis

2016 ◽  
Vol 34 (8) ◽  
pp. 1475-1480 ◽  
Author(s):  
Cordula Netzer ◽  
Karin Urech ◽  
Thomas Hügle ◽  
Robyn Melanie Benz ◽  
Jeroen Geurts ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Subchondral Bone ◽  
Facet Joint ◽  
Facet Joint Osteoarthritis ◽  
Lumbar Spinal

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 Techniques of Surgery for Lumbar Spinal Stenosis: A comparative study

2018 ◽  
Vol 32 (2) ◽  
pp. 240-261
Author(s):  
Gabriel Iacob ◽  
Abdul Salam ◽  
Abdul Rahman Hawis
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Study Groups ◽  
Common Type ◽  
Lumbar Canal Stenosis ◽  
Canal Stenosis ◽  
Lateral Recess Stenosis ◽  
Group A ◽  
Group B ◽  
Lumbar Spinal

Abstract Aim: To compare between classic open surgeries and minimally invasive surgeries in Lumbar Spinal Stenosis. Methods: A comparative descriptive study, involved 117 patients suffering from lumbar canal stenosis, aged between 40-70 years; admitted to department of Neurosurgery from March 2011 till august 2016 in King Fahad Hospital in Saudi Arabia. Study groups are consisted of group A as patients managed with classical laminectomy, group B as patients managed with Endoscopic spinal procedures and group C as patients managed with Microscopic decompression facilitated by the Metrex Tubular System. SPSS was used in data entry and analysis, and ethical considerations taken into consideration and participants filled the required inform consents. Results: Age of particaoncet ranged from 45 - 63 Year, Mean +/- 50. The degenerative canal stenosis with acute disc single level (cauda equina syndrome) was the most common type of lumbar canal stenosis encountered in group A, the unilateral foraminal and lateral recess stenosis without disc prolapse was the most common type of lumbar canal stenosis encountered in group B, while The unilateral foraminal and lateral recess stenosis without disc prolapse was the most common type of lumbar canal stenosis encountered in group C. Classic laminectomy and disectomy used mostly in group A, endoscopic unilateral decompression lamino-foraminotomy without discectomy used mostly in group B and bilateral microscopic laminectomy without discectomy followed by unilateral microscopic lamino-foraminotomy without discectomy used mostly in group C. Mean of operation duration was the highest in both gender of group A, followed by group B, then group C. Unintended durotomy was the most common intra operative complications occurred in the whole study especially in group A. Mean of blood lost was the highest in both gender of group A, followed by group B, then group C. Postop complications in the patients of study Groups was the highest in group A (33.3 %) ,followed by group B (8.5 %) and then group C (2 %). Conclusion: Microscopic decompression facilitated by the Metrex Tubular System is the most effective techniques of Surgery for Lumbar Spinal Stenosis and the least intraoperative and post-operative complications.

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