Comparison of clinical outcomes following minimally invasive or lumbar endoscopic unilateral laminotomy for bilateral decompression

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Minimally invasive lumbar unilateral tubular laminotomy for bilateral decompression has gradually gained acceptance as a less destabilizing but efficacious and safe alternative to traditional open decompression techniques. The authors have further advanced the principles of minimally invasive surgery (MIS) by utilizing working-channel endoscope–based techniques. Full-endoscopic technique allows for high-resolution off-axis visualization of neural structures within the lateral recess, thereby minimizing the need for facet joint resection. The relative efficacy and safety of MIS and full-endoscopic techniques have not been directly compared.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>A retrospective analysis of 95 consecutive patients undergoing either MIS (n = 45) or endoscopic (n = 50) unilateral laminotomies for bilateral decompression in cases of lumbar spinal stenosis was performed. Patient demographics, operative details, clinical outcomes, and complications were reviewed.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>The patient cohort consisted of 41 female and 54 male patients whose average age was 62 years. Half of the patients had single-level, one-third had 2-level, and the remaining patients had 3- or 4-level procedures. The surgical time for endoscopic technique was significantly longer per level compared to MIS (161.8 ± 6.8 minutes vs 99.3 ± 4.6 minutes; p &lt; 0.001). Hospital stay for MIS patients was on average 2.4 ± 0.5 days compared to 0.7 ± 0.1 days for endoscopic patients (p = 0.001). At the 1-year follow-up, endoscopic patients had a significantly lower visual analog scale score for leg pain than MIS patients (1.3 ± 0.3 vs 3.0 ± 0.5; p &lt; 0.01). Moreover, the back pain disability index score was significantly lower in the endoscopic cohort than in the MIS cohort (20.7 ± 3.4 vs 35.9 ± 4.1; p &lt; 0.01). Two patients in the MIS group (epidural hematoma) and one patient in the endoscopic group (disc herniation) required a return to the operating room acutely after surgery (&lt; 14 days).</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>Lumbar endoscopic unilateral laminotomy for bilateral decompression is a safe and effective surgical procedure with favorable complication profile and patient outcomes.</jats:p></jats:sec>

Comparison of Full-Endoscopic Visualized Unilateral Laminotomy Bilateral Decompression and Minimally Invasive Transforaminal Lumbar Interbody Fusion for One-Level Lumbar Spinal Stenosis

“…Excessive facetectomy may be inevitable for su cient lateral recess decompression and foraminotomy, exacerbating postoperative instability. In the present study, undercutting of the cranial lamina was performed during FEV-ULBD to overcome the di culty during insertion of the working sheath [4]. Additionally, the excellent endoscopic visualization achieved during FEV-ULBD ensure the undercutting of the cranial lamina, minimized facetectomy, and su cient decompression of the lateral recess and foramen.…”

“…The advantages of FEV-ULBD were to perform bilateral decompression via a unilateral approach with minimize traumatization to the paraspinal musculoligamentous structures; to ensure the su cient decompression the lateral recess and foramen under excellent endoscopic visualization to minimize neurological injury; and to preserve the stability of the spine with minimized foraminotomy [4,8,10,11]. On the other hand, FEV-ULBD has some disadvantages, such as the steep learning curve.…”

“…Microscopic laminotomy and foraminotomy remains the gold standard for the decompression of LSS [7,8]. Minimally invasive unilateral laminotomy bilateral decompression was performed to treat LSS with less injury to the paraspinal musculoligamentous structures [4,9]. To further minimize injury to the paraspinal musculoligamentous structures, full-endoscopic visualized unilateral laminotomy bilateral decompression (FEV-ULBD) has been used to treat LSS in recent years [4,8,10,11].…”

Comparison of lumbar endoscopic unilateral laminotomy bilateral decompression and minimally invasive surgery transforaminal lumbar interbody fusion for one-level lumbar spinal stenosis

“…Exclusion criteria were as follows: patients with (1) degenerative spondylolisthesis or deformity; (2) tumors, infections, or other lesions; and (3) a surgical history involving the corresponding segment [4,20].…”

“…Lumbar spinal stenosis (LSS) can be caused by degenerative facet joints, hypertrophic ligamentumavum, bulging or protrusion of the intervertebral discs, spondylolisthesis and or a combination of the above pathological lesions [1,2]. These pathological lesions may cause radicular leg pain and neurogenic claudication [1,3,4]. Surgery may be necessary to relieve the symptoms and improve function after failed conservative treatment in patients with LSS [1,3,5].…”