Contralateral facet-sparing sublaminar endoscopic foraminotomy for the treatment of lumbar lateral recess stenosis: technical note

Krzok, Guntram; Telfeian, Albert E.; Wagner, Ralf; Hofstetter, Christoph P.; Iprenburg, Menno

doi:10.21037/jss.2017.06.11

Cited by 9 publications

(10 citation statements)

References 16 publications

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“…Previous reports have presented that one of the drawbacks in MIS bilateral decompression via unilateral approach is incomplete decompression, especially, contralateral root decompression [37, 38]. It is due to very limited operative view and working space to manipulate the surgical instruments during the operation.…”

Section: Discussionmentioning

confidence: 99%

Comparative Analysis between Three Different Lumbar Decompression Techniques (Microscopic, Tubular, and Endoscopic) in Lumbar Canal and Lateral Recess Stenosis: Preliminary Report

Lee¹,

Yoon²,

Ha³

2019

BioMed Research International

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Purpose. The purpose of our study is to compare the results of spinal decompression using the full-endoscopic interlaminar technique, tubular retractor, and a conventional microsurgical laminotomy technique and evaluate the advantages and clinical feasibility of minimally invasive spinal (MIS) lumbar decompression technique in the lumbar canal and lateral recess stenosis. Methods. The authors retrospectively reviewed clinical and radiological data from 270 patients who received microsurgical (group E: 72 patients), tubular (group T: 34 patients), or full-endoscopic decompression surgery (group E: 164 patients) for their lumbar canal and lateral recess stenosis from June 2016 to August 2017. Clinical (VAS, ODI, and Mcnab criteria), radiologic (spinal canal diameter, segmental dynamic angle, and disc height), and surgical outcome parameters (CPK level, Operative time, blood loss, and hospital stay) were evaluated pre- and postoperatively and compared among the three groups by means of statistical analysis. Failed cases and complications were reviewed in all groups. Results. The mean follow-up period was 6.38 months. The Overall clinical success rate was 89.4%. All groups showed favorable clinical outcome. The clinical and radiologic results were similar in all groups. Regarding surgical outcome, group E showed longer operation time than group M and T (group E: 84.17 minutes/level, group M: 52.22 minutes/level, and group T: 66.12 minutes/level) (p<0.05). However, groups E and T showed minimal surgical invasiveness compared with group M. Groups E and T showed less immediate postoperative back pain (VAS) (group E: 3.13, group M: 4.28, group T: 3.54) (p<0.05), less increase of serum CPK enzyme (group E: 66.38 IU/L, group M: 120 IU/L, and group T: 137.5 IU/L) (p<0.05), and shorter hospital stay (group E: 2.12 days, group M: 4.85 days, and group T: 2.83 days) (p<0.05). The rates of complications and revisions were not significantly different among the three groups. Conclusions. MIS decompression technique is clinically feasible and safe to treat the lumbar canal and lateral recess stenosis, and it has many surgical advantages such as less muscle trauma, minimal postoperative back pain, and fast recovery of the patient compared to traditional open microscopic technique.

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Section: Discussionmentioning

confidence: 99%

Comparative Analysis between Three Different Lumbar Decompression Techniques (Microscopic, Tubular, and Endoscopic) in Lumbar Canal and Lateral Recess Stenosis: Preliminary Report

Lee¹,

Yoon²,

Ha³

2019

BioMed Research International

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“…2 More recently with improvements in camera technology and the development of better instruments, surgeons have more readily used the endoscope in direct approaches to the spine by interlaminar techniques allowing the treatment of degenerative spinal pathology, resecting yellow ligament, overgrown facet joints, and osteophytes. Thus, current working-channel endoscopy may be utilized to treat foraminal, 3 lateral recess, 4,5 and central spinal stenosis. [6][7][8] Using a unilateral approach, bilateral decompression of central and lateral recess stenosis in the lumbar spine is feasible and has been demonstrated to result in favorable clinical outcomes.…”

Section: Introductionmentioning

confidence: 99%

AOSpine Consensus Paper on Nomenclature for Working-Channel Endoscopic Spinal Procedures

Hofstetter

Ahn

Choi

et al. 2020

Global Spine Journal

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100

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Study Design: International consensus paper on a unified nomenclature for full-endoscopic spine surgery. Objectives: Minimally invasive endoscopic spinal procedures have undergone rapid development during the past decade. Evolution of working-channel endoscopes and surgical instruments as well as innovation in surgical techniques have expanded the types of spinal pathology that can be addressed. However, there is in the literature a heterogeneous nomenclature defining approach corridors and procedures, and this lack of common language has hampered communication between endoscopic spine surgeons, patients, hospitals, and insurance providers. Methods: The current report summarizes the nomenclature reported for working-channel endoscopic procedures that address cervical, thoracic, and lumbar spinal pathology. Results: We propose a uniform system that defines the working-channel endoscope (full-endoscopic), approach corridor (anterior, posterior, interlaminar, transforaminal), spinal segment (cervical, thoracic, lumbar), and procedure performed (eg, discectomy, foraminotomy). We suggest the following nomenclature for the most common full-endoscopic procedures: posterior endoscopic cervical foraminotomy (PECF), transforaminal endoscopic thoracic discectomy (TETD), transforaminal endoscopic lumbar discectomy (TELD), transforaminal lumbar foraminotomy (TELF), interlaminar endoscopic lumbar discectomy (IELD), interlaminar endoscopic lateral recess decompression (IE-LRD), and lumbar endoscopic unilateral laminotomy for bilateral decompression (LE-ULBD). Conclusions: We believe that it is critical to delineate a consensus nomenclature to facilitate uniformity of working-channel endoscopic procedures within academic scholarship. This will hopefully facilitate development, standardization of procedures, teaching, and widespread acceptance of full-endoscopic spinal procedures.

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“…15,48 The spectrum of indications for full endoscopic techniques has enlarged from discectomy towards the treatment of LSS and LRS due to technical advancements in optics, instruments, and drills, and this particular surgery might be performed via a contralateral, interlaminar, or transforaminal approach. 8,9,47,49,50 A significant reduction in leg pain as well as clinical success rates ranging from 75.0% to 92.3% depending on the approach and the event of previous surgery have been reported for full endoscopic procedures. [8][9][10][11]22,47,[49][50][51][52][53][54][55][56][57][58][59][60] However, one major concern regarding the full endoscopic technique is the prolonged learning curve and the limited option to manage intraoperative complication such as dural tears or dissection of adhesive epidural tissue.…”

Section: Discussionmentioning

confidence: 99%

“…8,9,47,49,50 A significant reduction in leg pain as well as clinical success rates ranging from 75.0% to 92.3% depending on the approach and the event of previous surgery have been reported for full endoscopic procedures. [8][9][10][11]22,47,[49][50][51][52][53][54][55][56][57][58][59][60] However, one major concern regarding the full endoscopic technique is the prolonged learning curve and the limited option to manage intraoperative complication such as dural tears or dissection of adhesive epidural tissue. 49,[61][62][63] In contrast to the full endoscopic technique the microendoscopic decompression of LRS is solely performed via an interlaminar approach.…”

Section: Discussionmentioning

confidence: 99%

“…A multitude of different surgical techniques have been reported to achieve adequate decompression of the LSS and lumbar lateral recess stenosis (LRS) varying from open to microscopic to tubular endoscopic to shear endoscopic techniques. [8][9][10][11][12][13][14] Full endoscopic and tubular endoscopic procedures have been developed to reduce approachrelated trauma and both techniques have been applied with great success for the treatment of lumbar disc herniation, central canal stenosis, and synovial cyst resection. [15][16][17][18][19][20][21][22][23] Endoscopic techniques are well established for the treatment of degenerative disorders of the lumbar spine.…”

Section: Introductionmentioning

confidence: 99%

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Is Decompression and Partial Discectomy Advantageous Over Decompression Alone in Microendoscopic Decompression Of Monosegmental Unilateral Lumbar Recess Stenosis?

Burkhardt

Oertel

2021

Int J Spine Surg

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Background: Endoscopic techniques are well accepted as surgical technique for decompression of lumbar lateral recess stenosis (LRS). It is uncertain if there is a difference in clinical outcome for decompression alone (DA) or decompression with partial discectomy (DPD) for the treatment of LRS.Methods: All files of patients who underwent an endoscopic procedure for lumbar LRS were identified from a prospectively collected database. Preoperative magnetic resonance imaging and endoscopic video were analyzed with special focus on the technique of nerve root decompression. Clinical outcome was assessed via a personal examination, a standardized questionnaire including the numeric rating scale (NRS) for leg and back pain, the Oswestry disability index (ODI), and the modified MacNab criteria to assess functional outcome and clinical success.Results: Sixty-six patients were identified of which 57 attended for evaluation (86.4%). DA was performed in 15 (26.3%) patients and DPD in 42 patients (73.7%). The mean follow-up was 45.0 months (range: 16-82 months). Fifty-two patients reported to be free of leg pain (91.1%), 42 patients had no noticeable back pain (73.7%), 49 patients had full muscle strength (85.9%), and 48 patients had no sensory disturbance (84.2%). The mean NRS for leg pain was 1, the mean NRS for back pain was 2, mean ODI was 16% (range: 0%-60%). Clinical success was noted in 49 patients (85.9%) and it was significantly higher for patients following DPD (P ¼ .024). The overall repeat procedure rate was 12% with reoperation rate at the index segment in 10.5% of cases. There were no significant differences with respect to leg and back pain, ODI, and reoperation between both groups.Conclusion: Microendoscopic DPD of LRS achieves a 92% clinical success rate which is significantly higher compared to 67% clinical success achieved by DA. There was no significant difference for the rate of reoperation, leg and back pain, and ODI.

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Contralateral facet-sparing sublaminar endoscopic foraminotomy for the treatment of lumbar lateral recess stenosis: technical note

Cited by 9 publications

References 16 publications

Comparative Analysis between Three Different Lumbar Decompression Techniques (Microscopic, Tubular, and Endoscopic) in Lumbar Canal and Lateral Recess Stenosis: Preliminary Report

Comparative Analysis between Three Different Lumbar Decompression Techniques (Microscopic, Tubular, and Endoscopic) in Lumbar Canal and Lateral Recess Stenosis: Preliminary Report

AOSpine Consensus Paper on Nomenclature for Working-Channel Endoscopic Spinal Procedures

Is Decompression and Partial Discectomy Advantageous Over Decompression Alone in Microendoscopic Decompression Of Monosegmental Unilateral Lumbar Recess Stenosis?

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