Comparison of full-endoscopic and minimally invasive decompression for lumbar spinal stenosis in the setting of degenerative scoliosis and spondylolisthesis

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>The management of lumbar spinal stenosis (LSS) with concurrent scoliosis and/or spondylolisthesis remains controversial. Full-endoscopic unilateral laminotomy for bilateral decompression (ULBD) facilitates neural decompression while preserving stabilizing osseoligamentous structures and may be uniquely suited for the treatment of LSS with concurrent mild to moderate degenerative deformity. The safety and efficacy of full-endoscopic versus minimally invasive surgery (MIS) ULBD in this patient population is studied here for the first time.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>A retrospective analysis of prospectively collected data was conducted on 45 consecutive LSS patients with concurrent scoliosis (≥ 10° coronal Cobb angle) and/or spondylolisthesis (≥ 3 mm). Patient demographics, operative details, complications, and imaging characteristics were reviewed. Outcomes were quantified using back and leg visual analog scale (VAS) scores and the Oswestry Disability Index (ODI) at 2 weeks, 3 months, and 1 year.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>A total of 26 patients underwent full-endoscopic and 19 underwent MIS-ULBD with an average follow-up period of 12 months. The endoscopic cohort experienced a significantly shorter hospital length of stay (p = 0.014) and fewer adverse events (p = 0.010). Both cohorts experienced significant improvements in VAS and ODI scores at all time points (p &lt; 0.001), but the endoscopic cohort demonstrated significantly better early ODI scores (p = 0.024).</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>Endoscopic and MIS-ULBD result in similar functional outcomes for LSS with mild to moderate deformity, while the endoscopic approach demonstrates a favorable rate of complications. Further studies are required to better delineate the characteristics of spinal deformities amenable to this approach and the durability of functional results.</jats:p></jats:sec>

Lumbar Endoscopic Unilateral Laminotomy for Bilateral Decompression Outside-In Approach: A Proctorship Guideline With 12 Steps of Effectiveness and Safety

“…Overall revision rate is 1.9%, incidental durotomy rate around 0%-8.6%, transient paresthesia around 2.6%, epidural hematoma and headache each around 1.9%. 3,7,12,[22][23][24][25][26] These complications are comparable in some and favorable in other studies as compared to open and minimally invasive spinal decompression. [27][28][29][30][31] Infection rate is extremely low in minimally invasive surgery.…”

“…This complication rate was comparable to other similar studies. 25 None of the complications required conversion or revision surgery. Incidental durotomy in our LE-ULBD series was small and only required patch blocking dural repair.…”

Inside-Out Approach of Lumbar Endoscopic Unilateral Laminotomy for Bilateral Decompression: A Detailed Technical Description, Rationale and Outcomes

“…[29][30][31] The benefit extends even to lumbar stenosis cases with spondylolisthesis. 32 Additionally, there are also several studies describing similar favorable results bewww.e-neurospine.org S95 tween microsurgical or tubular techniques of ULBD and endoscopic lumbar decompression in the setting of lumbar stenosis, with shorter hospital stay and less collateral tissue injury. 33,34 It may be reasonable to infer from these reports that endoscopic stenosis decompression can also deliver adequate decompression comparable to ULBD and open laminectomy.…”

<p>Clinical Comparison of Full-Endoscopic and Microscopic Unilateral Laminotomy for Bilateral Decompression in the Treatment of Elderly Lumbar Spinal stenosis: A Retrospective Study with 12-Month Follow-Up</p>

“…21 With the advancement of surgical technology and the improvement of instruments, several studies have reported favorable results in the treatment of LSS with full-endoscopic ULBD. [22][23][24][25][26] So far, there have been few studies comparing fullendoscopic and microscopic ULBD in the treatment of elderly lumbar spinal stenosis. Thus, the objective of this study was to evaluate the safety and efficacy of fullendoscopic ULBD compared with that of microscopic ULBD for treating elderly lumbar spinal stenosis, who usually has comorbidities such as hypertension, diabetes, and heart disease.…”