Microendoscopic Decompression Surgery for Lumbar Spinal Canal Stenosis via the Paramedian Approach: Preliminary Results

Abstract

The objective of this study was to evaluate the efficacy of a microendoscopic spinal decompression surgical technique using a novel approach for the treatment of lumbar spinal canal stenosis (LSCS). The following modifications were made to the conventional microendoscopic bilateral decompression via the unilateral approach: the base of the spinous process was first resected partially to secure a working space, so as not to separate the spinous process from the lamina. The tip of the tubular retractor was placed at the midline of the lamina, where laminectomy was performed microendoscopically. A total of 126 stenotic levels were decompressed in 70 patients. The mean operating time per level was 77.0 minutes, and the mean intraoperative blood loss per level was 15.0 mL. There were no dural tears or neurological injuries intraoperatively. Fracture of the spinous process was detected postoperatively in two patients, both of whom were asymptomatic. All patients could be followed up for at least 12 months. Their median Japanese Orthopaedic Association (JOA) score improved significantly from 16 points preoperatively to 27.5 points after the surgery (p < 0.001). The case series showed that the modifications of the technique improved the safety and ease of performance of the microendoscopic decompression surgery for LSCS.

Microendoscopic bilateral Decompression via Unilateral Approach in Single and Multiple Level Lumbar Canal Stenosis: A Series of 583 Cases

“…The rationale of MEDL is to attempt maximal preservation the facet joint, bony anatomy, ligamentous structures and paravertebral muscles in order to maintain spinal stability; however fractures can occur to spinous process. 34 In this series, 0.5% of patients experienced asymptomatic intraoperative fracture of the spinous process.…”

“…28 Inspired by Foley and Smith's microendoscopic discectomy procedure dedicated for disc herniation pathologies, microendoscopic decompression laminotomy (MEDL) via unilateral approach has emerged as an outstanding treatment for LCS. 12,34 Despite technical skills that ought to be gained and intra-procedurally met technical difficulties; microendoscopic unilateral laminotomy for bilateral decompression is coupled with various benefits like maintenance of spinal stability, better patient satisfaction and relatively low rate of complication. 20,21,41 The purpose of this study is to investigate the efficacy of the technique in a large cohort having single and multiple LCS and also to portray its safety, clinical and functional outcome through short-term follow-up.…”

Perioperative outcomes in minimally invasive lumbar spine surgery: A systematic review

“…Laminectomy: Unilateral laminectomy for bilateral decompression LSS, no spondylolisthesis > 1 74 -Nomura et al [22] 2012 Laminectomy: Unilateral laminectomy for bilateral decompression: Paramedian approach LSS, no discectomy 70 -Tomasino et al [23] 2009 Laminectomy: Unilateral laminectomy for bilateral decompression LSS, herniation in obese 28 -Wada et al [24] [14] 259 ± 122 193 ± 68 154 ± 135 132 ± 128 --4.0 ± 2.9 7.2 ± 1.6 Usman et al [15] 69 ± 0.1 65 ± 0.1 ----4.7 ± 0.5 3.5 ± 0.5 Mobbs et al [17] - [18] 110 ± 10 157 ± 7 52 ± 14 246 ± 32 5% 8% 2.1 ± 0.7 4.1 ± 0.4 Nomura et al [19] 187 ± 68 -90 ± 94 -2% ---Parikh et al [20] 118 ± 40 -41 ± 90 -11% -1.2 1.3 Komp et al [21] …”

“…-0 1 -14% ---Nomura et al [22] [23] 102 ± 44 -35 ± 76 -11% -2.1 2.2 Wada et al [24] 144 -60 -7% --- [27] 2014 XLIF Retrospective cohort, XLIF vs ALIF DDD, FBSS, spondylolisthesis 88 120 Smith et al [28] 2012 XLIF Retrospective cohort, XLIF vs ALIF DDD, LSS, FBSS, spondylolisthesis, herniation 115 87 1 Rodgers et al [12] 2010 XLIF Retrospective cohort, XLIF vs PLIF > 80 yr, LSS, FBSS spondylolisthesis, scoliosis, fracture 40 20 Huang et al [29] 2010 MIS-ALIF 2 Prospective cohort, MIS-ALIF vs ALIF Not defined 10 13 Case series 3 Rodgers et al [13] 2011 XLIF PCS LSS, DDD, FBSS, spondylolisthesis, scoliosis 600 -Ruetten et al [30] 2005 XLIF RCS Lumbar disc prolapse 463 -Lykissas et al [31] 2014 XLIF RCS Degenerative spinal conditions 144 -Grimm et al [32] 2014 XLIF RCS DDD, LSS, FBSS, scoliosis, spondylolisthesis, herniation 108 -Tohmeh et al [33] 2011 XLIF PCS LSS, DDD, spondylolisthesis, spondylosis, scoliosis, recurrent herniation, ASD…”

How I do it? Biportal endoscopic spinal surgery (BESS) for treatment of lumbar spinal stenosis

“…The use of Kerrison rongeurs, a high-speed drill, and an ultrasonic bone cutter enables the lateral recess to be enlarged while keeping the facet joint intact. The endpoint of decompression is the outer edges of the bilateral nerve roots [ 6 ]. Continuous saline irrigation at 25 to 30 mmHg maintains a clear surgical view and preserves the epidural fat and vessels from damage, which may happen during the microendoscopic decompression surgery.…”