Lumbar Endoscopic Unilateral Laminotomy for Bilateral Decompression for Lumbar Spinal Stenosis Provides Comparable Clinical Outcomes in Patients with and without Degenerative Spondylolisthesis

Yoshikane, Koichi; Kikuchi, Katsuhiko; Okazaki, Ken

doi:10.1016/j.wneu.2021.03.018

Cited by 14 publications

(7 citation statements)

References 25 publications

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“…In a study by Park et al ( 17 ), ULBD achieved satisfactory clinical outcomes for grade I lumbar spondylolisthesis with nerve root symptoms, but foraminal stenosis was a contraindication. In a study by Yoshikane et al ( 18 ), endoscopic ULBD provided favorable outcomes for lumbar spinal stenosis with or without grade I lumbar spondylolisthesis, but 31% of patients with lumbar spondylolisthesis experienced aggravation of their condition. Although a few reports show that ULBD alone can provide positive outcomes, previous studies still support that interbody fusion is an effective method for treating lumbar spondylolisthesis ( 20 ).…”

Section: Discussionmentioning

confidence: 98%

“…The position of the incision is slightly different among reports but is generally 0.5–2 cm from the midline ( 5 – 7 , 24 , 25 ). Endoscopic ULBD can improve surgical visualization, reduce postoperative low back pain, and shorten postoperative hospital stay ( 6 , 7 , 18 , 24 , 25 ). Some scholars have reported the utilization of unilateral biportal endoscopic ULBD, with the insertion point being more medial than that in unilateral biportal endoscopic interbody fusion (UBE) to protect facet joints, resulting in positive clinical outcomes ( 26 ).…”

Section: Discussionmentioning

confidence: 99%

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Percutaneous Endoscopic Posterior Lumbar Interbody Fusion with Unilateral Laminotomy for Bilateral Decompression Vs. Open Posterior Lumbar Interbody Fusion for the Treatment of Lumbar Spondylolisthesis

et al. 2022

Front. Surg.

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BackgroundEndoscopic lumbar interbody fusion is a new technology that is mostly used for single-segment and unilateral lumbar spine surgery. The purpose of this study is to introduce percutaneous endoscopic posterior lumbar interbody fusion (PE-PLIF) with unilateral laminotomy for bilateral decompression (ULBD) for lumbar spondylolisthesis and evaluate the efficacy by comparing it with open posterior lumbar interbody fusion (PLIF).MethodsTwenty-eight patients were enrolled in PE-PLIF with the ULBD group and the open PLIF group. The perioperative data of the two groups were compared to evaluate the safety of PE-PLIF with ULBD. The visual analog scale (VAS) back pain, VAS leg pain, and Oswestry Disability Index (ODI) scores of the two groups preoperatively and postoperatively were compared to evaluate clinical efficacy. Preoperative and postoperative imaging data were collected to evaluate the effectiveness of the operation.ResultsNo differences in baseline data were found between the two groups (p > 0.05). The operation time in PE-PLIF with the ULBD group (221.2 ± 32.9 min) was significantly longer than that in the PLIF group (138.4 ± 25.7 min) (p < 0.05), and the estimated blood loss and postoperative hospitalization were lower than those of the PLIF group (p < 0.05). The postoperative VAS and ODI scores were significantly improved in both groups (p < 0.05), but the postoperative VAS back pain score in the PE-PLIF group was significantly lower than that in the PLIF group (p < 0.05). The excellent and good rates in both groups were 96.4% according to MacNab’s criteria. The disc height and cross-sectional area of the spinal canal were significantly improved in the two groups after surgery (p < 0.05), with no difference between the groups (p > 0.05). The fusion rates in PE-PLIF with the ULBD group and the PLIF group were 89.3% and 92.9% (p > 0.05), respectively, the cage subsidence rates were 14.3% and 17.9% (p > 0.05), respectively, and the lumbar spondylolisthesis reduction rates were 92.72 ± 6.39% and 93.54 ± 5.21%, respectively (p > 0.05).ConclusionThe results from this study indicate that ULBD can be successfully performed during PE-PLIF, and the combined procedure is a safe and reliable treatment method for lumbar spondylolisthesis.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Percutaneous Endoscopic Posterior Lumbar Interbody Fusion with Unilateral Laminotomy for Bilateral Decompression Vs. Open Posterior Lumbar Interbody Fusion for the Treatment of Lumbar Spondylolisthesis

et al. 2022

Front. Surg.

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“…These results were comparable with those reported previously. 15 However, reoperation was required owing to symptom recurrence in 13 patients (10%). Factors related to the risk of reoperation for multilevel LSS were revealed to be dependent on whether the preoperative symptom occurred in the lower leg bilaterally or unilaterally, and stenosis severity was classified on the basis of MRI findings.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Selective Single-Level Lumbar Endoscopic Unilateral Laminotomy for Bilateral Decompression of Multilevel Lumbar Spinal Stenosis and Risk Factors of Reoperation

Yoshikane

Kikuchi

Okazaki

2021

Global Spine Journal

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Study Design: Retrospective cohort study. Objectives: To investigate the usefulness of selective single-level lumbar endoscopic unilateral laminotomy for bilateral decompression (LE-ULBD) in patients with radiological multilevel lumbar spinal stenosis (LSS) and clarify the predictive factors of reoperation. Methods: A total of 128 patients who underwent LE-ULBD of radiological multilevel LSS were retrospectively examined. Single-level decompression was selected clinically and supplemented radiologically. Clinical outcomes were assessed with the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), numeric rating scale (NRS), and Macnab criteria (mean follow-up period, 28.6 months [range, 24-63 months]). Stenosis severity was classified as grades M (moderate) and S (severe) based magnetic resonance imaging findings. Multilevel LSS was classified as SS, SM, and MM according to the number of grade S levels. Results: The follow-up rate was 74.2%. All domains of the JOABPEQ and NRS significantly improved during follow-up. The Macnab outcome classification was “excellent” or “good” in 77.9% of the patients. The reoperation rate was 10.2%. None of the patients with unilateral symptoms required reoperation. The SS type was a significant risk factor of reoperation for multilevel LSS with bilateral symptoms. Additional LE-ULBD was performed for all the reoperation with the “excellent” or “good” results of the Macnab criteria in 69% of the patients. Conclusions: Selective single-level LE-ULBD provided favorable results for multilevel LSS. However, information about the risks of reoperation for multilevel severe stenosis with bilateral symptoms should be shared between surgeons and patients.

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“…Percutaneous or full-endoscopic procedures have shown good outcomes and decompression effectiveness in patients with lumbar central, lateral recess, and foraminal stenosis [6][7][8][9]. Due to the minimally invasive nature of the procedure, transforaminal endoscopic approaches minimize the surgical footprint sparing the stabilizing structures such as ligaments, muscles, and facet joints.…”

Section: Neurogenic Claudication Produced By Combined Centralmentioning

confidence: 99%

Full-endoscopic Foraminotomy in Degenerative Spondylolisthesis: A “Module-based” Approach for Surgical Planning and Execution

Isseldyk

Lim

Kim

et al. 2022

J Minim Invasive Spine Surg Tech

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Purpose Degenerative Lumbar Spondylolisthesis (DSL) is a common spinal pathology characterized by the anterior slippage of one vertebral body on another. DSL is caused mainly by degeneration of the intervertebral disc in the first place, with subsequent degeneration of the facet joints that end causing the slippage. As the disease evolves, stability is restored as a result of advanced degeneration and disc collapse. But while this natural evolution takes place, DSL may produce radicular symptoms by different mechanisms. To present a “module-based” approach for the surgical planning and execution of full-endoscopic foraminotomy in DSL, combined with case examples of the most common surgical scenarios. Methods We propose a “module-based surgery” using the standard endoscopic foraminotomy technique as a baseline. According to the patient’s clinical and imaging characteristics, several “modules” can be added. The resulting endoscopic surgery is a summation of the basic endoscopic foraminotomy plus all the additional required modules. ResultsSurgical modules description and case examples are provided. ConclusionTransforaminal lumbar endoscopic foraminotomy represents a minimally invasive technique to treat foraminal and combined foraminal-lateral recess stenosis. DSL and its multiple scenarios represent a challenge to the endoscopic surgeon. Module-based approach can help systematize and execute these demanding endoscopic procedures.

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Lumbar Endoscopic Unilateral Laminotomy for Bilateral Decompression for Lumbar Spinal Stenosis Provides Comparable Clinical Outcomes in Patients with and without Degenerative Spondylolisthesis

Cited by 14 publications

References 25 publications

Percutaneous Endoscopic Posterior Lumbar Interbody Fusion with Unilateral Laminotomy for Bilateral Decompression Vs. Open Posterior Lumbar Interbody Fusion for the Treatment of Lumbar Spondylolisthesis

Percutaneous Endoscopic Posterior Lumbar Interbody Fusion with Unilateral Laminotomy for Bilateral Decompression Vs. Open Posterior Lumbar Interbody Fusion for the Treatment of Lumbar Spondylolisthesis

Clinical Outcomes of Selective Single-Level Lumbar Endoscopic Unilateral Laminotomy for Bilateral Decompression of Multilevel Lumbar Spinal Stenosis and Risk Factors of Reoperation

Full-endoscopic Foraminotomy in Degenerative Spondylolisthesis: A “Module-based” Approach for Surgical Planning and Execution

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