Surgical Outcomes of Microscopic versus Unilateral Biportal Endoscopic Decompression for Lumbar Spinal Stenosis: A Preliminary Report

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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Clinical and Radiological Outcomes of Unilateral Biportal Endoscopic Decompression by 30° Arthroscopy in Lumbar Spinal Stenosis: Minimum 2-Year Follow-up

Clinics in Orthopedic Surgery ◽

10.4055/cios.2018.10.3.328 ◽

2018 ◽

Vol 10 (3) ◽

pp. 328 ◽

Cited By ~ 15

Author(s):

Ju-Eun Kim ◽

Dae-Jung Choi

Keyword(s):

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Endoscopic Decompression ◽

Lumbar Spinal

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

Journal of Neurosurgery Spine ◽

10.3171/2015.7.spine15304 ◽

2016 ◽

Vol 24 (4) ◽

pp. 602-607 ◽

Cited By ~ 62

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.

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Prognostic Factors for Surgical Outcomes Including Preoperative Total Knee Replacement and Knee Osteoarthritis Status in Female Patients With Lumbar Spinal Stenosis

Journal of Spinal Disorders & Techniques ◽

10.1097/bsd.0b013e31828d003d ◽

2015 ◽

Vol 28 (2) ◽

pp. 47-52 ◽

Cited By ~ 2

Author(s):

Byung Ho Lee ◽

Tae-Hwan Kim ◽

Hyun-Soo Chong ◽

Seung-Hwan Lee ◽

Jin-Oh Park ◽

...

Keyword(s):

Prognostic Factors ◽

Total Knee Replacement ◽

Knee Osteoarthritis ◽

Spinal Stenosis ◽

Knee Replacement ◽

Lumbar Spinal Stenosis ◽

Surgical Outcomes ◽

Female Patients ◽

Total Knee ◽

Lumbar Spinal

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Therapeutic Effect of Large Channel Endoscopic Decompression in Lumbar Spinal Stenosis

Frontiers in Surgery ◽

10.3389/fsurg.2021.603589 ◽

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 < 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.

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