Lumbar Endoscopic Bony and Soft Tissue Decompression With the Hybridized Inside-Out Approach: A Review And Technical Note

Abstract

This study aimed to showcase the authors' preferred technique of a hybrid of modern "inside-out" and "outside-in" endoscopic decompression. A case series of 411 patients consisting of 192 females (46.7%) and 219 males (53.3%) with an average age of 54.84 ± 16.32 years and an average of 43.2 ± 26.53 months are presented. Patients underwent surgery for low-grade spondylolisthesis (13 of 411, 3.2%), herniated disc (135 of 411, 32.8%), foraminal spinal stenosis (101 of 411, 24.6%), or a combination of the latter 2 conditions (162 of 411, 39.4%). The preoperative Oswestry Disability Index (ODI) and visual analogue scale (VAS) for leg pain were 49.8 ± 17.65 and 7.9 ± 1.55, respectively. Postoperative ODI and VAS leg were 12.2 ± 9.34 and 2.41 ± 5 1.55 at final follow-up (p < 0.0001). MacNab outcomes were excellent in 134 (32.6%), good in 228 (55.5%), fair in 40 (9.7%), and poor in 9 patients (2.2%), respectively. There was end-stage degenerative vacuum disc disease in 304 of the 411 patients (74%) of which had 37.5% had excellent and 50% good MacNab outcomes. Patients without vacuum discs had excellent and good 18.7% and 71.0% of the time. Direct visualization of pain generators in the epidural-and intradiscal space is the authors' preferred transforaminal decompression technique and is supported by their reliable clinical outcomes.

A Proposed Personalized Spine Care Protocol (SpineScreen) to Treat Visualized Pain Generators: An Illustrative Study Comparing Clinical Outcomes and Postoperative Reoperations between Targeted Endoscopic Lumbar Decompression Surgery, Minimally Invasive TLIF and Open Laminectomy

“…For several decades, this article’s first and senior authors have applied this context-driven spine care model in their routine clinical practice. [ 26 , 28 , 48 , 51 , 52 , 96 ] The authors’ methodology (SpineScreen) is similar to that of the Society for Brain Mapping and Therapeutics (SBMT), which proposed a multifaceted approach to Brain, Spine, and Mental Health Screening (NeuroScreen). [ 97 ] It will be described in the upcoming SBMT position paper on modern management of painful spine conditions.…”

“…The targeted ELD was achieved via the endoscopic transforaminal approach [ 47 , 48 , 51 , 74 , 75 , 76 , 77 , 78 , 79 ]. Patients underwent a foraminoplasty via partial resection of the superior articular process and the caudal pedicle [ 51 ].…”

“…The targeted ELD was achieved via the endoscopic transforaminal approach [ 47 , 48 , 51 , 74 , 75 , 76 , 77 , 78 , 79 ]. Patients underwent a foraminoplasty via partial resection of the superior articular process and the caudal pedicle [ 51 ]. Additionally, bony and soft tissue stenosis in the lateral spinal canal was treated.…”

“…Patients are reassured about the benign natural history of a herniated disc and spinal stenosis by proclaiming that symptoms should soon resolve with non-steroidal anti-inflammatories, physical therapy, and activity modification with short-term bed rest and early return to work whenever possible [ 43 , 44 , 45 , 46 ]. Nonetheless, many of these patients suffer from painful inflammatory or compressive conditions affecting the neural elements due to leakage from toxic annular tears and irritated facet joint cysts [ 47 , 48 , 49 , 50 , 51 ]. Many other pain generators frequently escape the routine lumbar MRI scan.…”

Anesthesia For Endoscopic Spine Surgery Of The Spine In An Ambulatory Surgery Center

“…In comparision, the majority of spinal endoscopies are percutaneous posterior procedures with neglible blood loss, minimal muscle dissection, and hardly any postoperative wound pain. These posterior transforaminal or interlaminar decompression procedures seem preferred by most endoscopic spine surgeons for greater versatility, simplicity, and lower risks to the vital structures in the spine [49][50][51][52][53][54][55][56][57][58].…”