Bilateral decompression of lumbar spinal stenosis involving a unilateral approach with microscope and tubular retractor system

Palmer, Sylvain; Turner, R. S.; Palmer, Rosemary

doi:10.3171/spi.2002.97.2.0213

Cited by 123 publications

(136 citation statements)

References 16 publications

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“…25,37 Recent randomized clinical trials draw a conclusion that laminectomy is superior to medical treatment in terms of functional outcome and symptomatic relief. 26 Furthermore, the functional improvement and clearance of radiating leg pain is long-term as evident in Spine Patient Outcomes Research Trial (SPORT).…”

Section: Discussionmentioning

confidence: 99%

Microendoscopic bilateral Decompression via Unilateral Approach in Single and Multiple Level Lumbar Canal Stenosis: A Series of 583 Cases

Kabil

Ebrahim

2017

Egyptian Spine Journal

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Background Data: Traditionally, lumbar canal stenosis (LCS) has been treated with conventional laminectomy involving wide resection of posterior supporting structures of the lumbar spine such as the supraspinous and inter-spinous ligamentum complex, the spinous process as well as wide areas of the lamina. In addition, this required a large incision of the skin and underlying musculoligamentous complex (posterior tension band). Purpose: The current study focuses on the clinical outcome and utility of minimally invasive microendoscopic decompression from a unilateral approach in surgical management of patients with single and multiple level lumbar canal stenosis. The objective is to describe the indications, significance and applications of endoscopic spine surgery in patients with single and multiple level LCS. Additionally, to highlight important anatomical perspectives of the technique and share surgical experience and results. Study Design: A retrospective clinical case study. Patients and Methods: From May 2008 to January 2016, 583 consecutive patients were treated for LCS and included in this study. Patients' main complaint was bilateral neurogenic claudication in addition to back pain and sciatic neuralgia. Single level decompression was performed in 468 (80%) patients and multiple level decompressions in 115 (20%) patients. Magnetic resonance imaging (MRI), computed tomography (CT) scan and plain X-rays were performed for all patients to confirm evidence of central stenosis and then repeated postoperatively. All patients were followed up for at least 3 months and their data collected. Clinical and functional outcomes were assessed using Visual Analogue Scale (VAS) and the Japanese Orthopedic Association Score (JOA) score for lumbar disease. Results: Compared to preoperative complaint, there was an improvement of back pain in 77.9% of patients and in radiating leg pain in 86.3%. With regards to functional outcomes, median preoperative JOA score was 14.93 ± 0.48 and improved postoperatively to 27.17 ± 1.45 (p < 0.001). The mean operating time per level was 78 minutes, and the mean intraoperative blood loss per level was 18 ml. Complications mainly included dural tears in 27 (4.6%) patients, transient postoperative dysesthesia in 46/583 (7.9%) patients and excess bony work in the form of unintended medial facetectomy in 38/583 (6.5%) patients and fracture of the spinous process in 3 (0.5%) patients.

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Section: Discussionmentioning

confidence: 99%

Microendoscopic bilateral Decompression via Unilateral Approach in Single and Multiple Level Lumbar Canal Stenosis: A Series of 583 Cases

Kabil

Ebrahim

2017

Egyptian Spine Journal

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“…8,18,19,28 Only a few surgeons are familiar with use of the endoscope, and therefore standard microscopic techniques have been adopted to perform the same operation as with the endoscope. 14,21 In addition, microscopic compatibility affords the surgeon 3D visualization of the surgical anatomy. Operating through tubes has evolved as a promising alternative that seems to be associated with decreased muscle trauma.…”

Section: Discussionmentioning

confidence: 99%

Operative results and learning curve: microscope-assisted tubular microsurgery for 1- and 2-level discectomies and laminectomies

Parikh¹,

Tomasino²,

Knopman³

et al. 2008

FOC

101

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Object The authors present their clinical results and the learning curve associated with the use of tubular retractors for 1- and 2-level lumbar microscope-assisted discectomies and laminectomies. Methods The study involves a retrospective and prospective analysis of 230 patients who underwent noninstrumented minimally invasive procedures for degenerative lumbar spinal disease between 2004 and 2007. Data on patient demographic characteristics and operative results, including length of stay, blood loss, operative times, and surgical complications were collected. Clinical outcomes were assessed based on pre- and postoperative Visual Analog Scale scores, Oswestry Disability Index values, and the Macnab outcome scale scores. Results The results showed characteristic differences in blood loss and operating times between 1- and 2-level procedures and between discectomies and laminectomies. A significant learning curve was seen by a decrease in operating time for 1- level discectomies and 2-level laminectomies. Major complications were not observed. Conclusions The use of tubular retractors for microsurgical decompression of degenerative spinal disease is a safe and effective treatment modality. As with other techniques, minimally invasive procedures are associated with a significant learning curve. As surgeons become more comfortable with the procedure, its applications can be expanded to include, for example, spinal instrumentation and deformity correction.

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“…The microscope is then utilized to visualize across the midline, and access is achieved to the contralateral recess of the spinal canal. Minimal access spinal technique was first adapted to this approach using METRx tubes, and this was reported independently by Fessler's group 44,63 and by Palmer et al 97 in 2002. Enhanced visualization is achieved by combining the use of a microscope that allows multidirectional movement (such as the Contraves [Zeiss]), wanding the tubular retractor, and side-tilting the operating table.…”

Section: Lumbar Spinal Stenosismentioning

confidence: 99%

Minimally invasive spine technology and minimally invasive spine surgery: a historical review

Oppenheimer

DeCastro

McDonnell

2009

FOC

206

130

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The trend of using smaller operative corridors is seen in various surgical specialties. Neurosurgery has also recently embraced minimal access spine technique, and it has rapidly evolved over the past 2 decades. There has been a progression from needle access, small incisions with adaptation of the microscope, and automated percutaneous procedures to endoscopically and laparoscopically assisted procedures. More recently, new muscle-sparing technology has come into use with tubular access. This has now been adapted to the percutaneous placement of spinal instrumentation, including intervertebral spacers, rods, pedicle screws, facet screws, nucleus replacement devices, and artificial discs. New technologies involving hybrid procedures for the treatment of complex spine trauma are now on the horizon. Surgical corridors have been developed utilizing the interspinous space for X-STOP placement to treat lumbar stenosis in a minimally invasive fashion. The direct lateral retroperitoneal corridor has allowed for minimally invasive access to the anterior spine. In this report the authors present a chronological, historical perspective of minimal access spine technique and minimally invasive technologies in the lumbar, thoracic, and cervical spine from 1967 through 2009. Due to a low rate of complications, minimal soft tissue trauma, and reduced blood loss, more spine procedures are being performed in this manner. Spine surgery now entails shorter hospital stays and often is carried out on an outpatient basis. With education, training, and further research, more of our traditional open surgical management will be augmented or replaced by these technologies and approaches in the future.

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Bilateral decompression of lumbar spinal stenosis involving a unilateral approach with microscope and tubular retractor system

Cited by 123 publications

References 16 publications

Microendoscopic bilateral Decompression via Unilateral Approach in Single and Multiple Level Lumbar Canal Stenosis: A Series of 583 Cases

Microendoscopic bilateral Decompression via Unilateral Approach in Single and Multiple Level Lumbar Canal Stenosis: A Series of 583 Cases

Operative results and learning curve: microscope-assisted tubular microsurgery for 1- and 2-level discectomies and laminectomies

Minimally invasive spine technology and minimally invasive spine surgery: a historical review

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