Full-endoscopic bilateral over-the-top decompression in lumbar central stenosis: surgical technique and outcomes

Siepe, Christoph J.; Bridts, Anna-Lena; Ayman, Mohamed; Sauer, Daniel; Mehren, Christoph

doi:10.1007/s00586-023-07750-0

Cited by 5 publications

(3 citation statements)

References 27 publications

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“…To avoid excessive removal of the lamina and reduce ligamentum flavum compression on the dural sac, a 2 mm diameter high-speed drill was used to adhere to the inner edge of the vertebral plate on the symptomatic side. In comparison with the over-the-top decompression technique ( 31 ), also referred to as lumbar endoscopic unilateral laminotomy for bilateral decompression, we can be more efficient grinding drills and operated with bimanualness. In addition, the over-the-top technique needs to be highlighted that performing a full-endoscopic decompression is a complex technique which requires advanced endoscopic skills and should only be considered for surgeons that are already familiar with this technique.…”

Section: Discussionmentioning

confidence: 99%

Contralateral approach using microscope and tubular retractor system for ipsilateral decompression of lumbar degenerative lateral recess stenosis associated with narrow spinal canal

Shu,

Mu,

Dai

et al. 2024

Front. Neurol.

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ObjectiveTo summarize the clinical effect of a single-center retrospective analysis of the contralateral approach with a microscope and tubular retractor system for ipsilateral decompression in patients with lumbar lateral recess stenosis and a narrow spinal canal.MethodsA total of 25 patients who underwent ipsilateral decompression surgery via a contralateral approach with microscope and tubular retractor system, performed by one surgeon at a single center were retrospectively examined. The width of the lamina fenestration was compared with the preoperative distance from the root of the spinous process to the dorsal articular facet, the bilateral articular facet change in the suprapedicle notch section on CT scan, and with the changes in transverse and sagittal diameters of the canal area on MRI. Clinical efficacy was assessed using the Japanese Orthopedic Association (JOA), Visual Analog Scale (VAS), and Oswestry Disability Index (ODI) scores.ResultsIn total, 25 patients were treated and the mean intraoperative time was 82.04 ± 12.48 min. There was no nerve injury, cerebrospinal fluid leakage, and infection complications. The postoperative CT revealed that the width of the contralateral laminar fenestration was less than the distance from the root of the spinous process to the dorsal articular facet. The residual widths of the ipsilateral articular facet and contralateral articular facet were greater than 2/3 of the preoperative articular facet width. The transverse and sagittal diameter of canal were significantly increased. The mean follow-up period was 12–16 months, and no recurrence or reoperation incidence were found at the last follow-up. When compared to pre-surgery, the ODI, VAS, and JOA scores were significantly improved after surgery (p < 0.05).ConclusionBased on our single-center retrospective observation of 25 cases and combined with previous literature, the contralateral approach with a microscope and tubular retractor system for ipsilateral decompression in patients with lumbar lateral recess stenosis and a narrow spinal canal can reduce damage to the articular processes, and probably more conducive to the postoperative stability of the lumbar spine. This was a single center retrospective analysis with a small sample size and lacked randomized controlled trials (RCTs). However, larger-scale, multicenter RTCs are required for additional validation.

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Section: Discussionmentioning

confidence: 99%

Contralateral approach using microscope and tubular retractor system for ipsilateral decompression of lumbar degenerative lateral recess stenosis associated with narrow spinal canal

Shu,

Mu,

Dai

et al. 2024

Front. Neurol.

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“…In addition, they point to the cost-effectiveness of the procedure because of its short operative time, rapid rehabilitation, low cost of postoperative care, and less anatomic trauma [63]. Recently, Siepe et al [66] described full-endoscopic bilateral overthe-top decompression for lumbar central stenosis, which represents the next step in reducing surgical invasiveness compared with microsurgical decompression. In addition, this procedure is clinically feasible, can be performed safely, and is an efficient surgical technique.…”

Section: Discussionmentioning

confidence: 99%

“…The rate of infections and wound healing problems are also significantly lower. However, this technique can be considered complex and should only be performed by surgeons who are at an advanced stage of the full-endoscopic learning curve [66].…”

Section: Discussionmentioning

confidence: 99%

Surgical Technique of Central and Over-the-Top Full-Endoscopic Decompression of the Cervical Spine: A Technical Note

Bergamaschi,

Brito,

Araújo

et al. 2023

JPM

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Endoscopic surgery of the cervical spine is constantly evolving and the spectrum of its indications has expanded in recent decades. Full-endoscopic techniques have standardized the procedures for posterior and anterior access. The full-endoscopic approach was developed to treat degenerative diseases with the least possible invasion and without causing instability of the cervical spine. The posterior full-endoscopic approach is indicated for the treatment of diseases of the lateral part of the vertebral segment, such as herniations and stenoses of the lateral recess and vertebral foramen. There has been little discussion of this approach to the treatment of central stenosis of the cervical spine. This technical note describes a step-by-step surgical technique for central and over-the-top full-endoscopic decompression in the cervical spine, using a 3.7 mm working channel endoscope. This technique has already been shown to be effective in a recent case series with a 4.7 mm working channel endoscope, and may represent a new treatment option for central or bilateral lateral recess stenosis. There is also the possibility of a bilateral full-endoscopic approach, but this may be associated with greater muscle damage and a longer operative time. Case series and comparative studies should be encouraged to confirm the safety and utility of this technique.

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Endoskopische Bandscheibenchirurgie

Siepe

2024

Die Wirbelsäule

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Nach initial offener Durchführung stellt der Einsatz des Operationsmikroskops heutzutage im Rahmen dekomprimierender Verfahren wie der operativen Behandlung von Bandscheibenvorfällen oder der Dekompression einer Spinalkanalstenose den Gold-Standard dar. Mit Einführung der vollendoskopischen Eingriffe in uniportalen Technik konnte die Invasivität der Eingriffe mit den bekannten Vorteilen der MIS-Chirurgie nochmals reduziert werden.

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Full-endoscopic bilateral over-the-top decompression in lumbar central stenosis: surgical technique and outcomes

Cited by 5 publications

References 27 publications

Contralateral approach using microscope and tubular retractor system for ipsilateral decompression of lumbar degenerative lateral recess stenosis associated with narrow spinal canal

Contralateral approach using microscope and tubular retractor system for ipsilateral decompression of lumbar degenerative lateral recess stenosis associated with narrow spinal canal

Surgical Technique of Central and Over-the-Top Full-Endoscopic Decompression of the Cervical Spine: A Technical Note

Endoskopische Bandscheibenchirurgie

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