Operative Therapie des engen Spinalkanals

Abstract

Surgical treatment of lumbar spinal stenosis is aimed at decompressing the structures of the spinal canal. Several surgical techniques have been described over the last few years. This article gives a survey of the surgical procedures used for the treatment of spinal stenosis. When comparing and discussing indications and current surgical techniques used for spinal stenosis, one can describe some general tendencies: if the symptoms are severe or disabling and do not respond to appropriate conservative treatment, or if the patient is not able to cope with the pain any longer and views his or her quality of life as unacceptable, surgery is indicated. If the symptoms are mainly radicular, (microsurgical) decompression should be performed. If back pain is the main problem combined with preoperative evidence of segmental instability, spondylolisthesis, or scoliosis, one should consider spinal fusion in addition to an appropriate decompression. Further investigations are necessary to exactly find out the appropriate indications for a fusion and to answer the question of whether spinal instrumentation should be used.

Surgical treatment for lumbar lateral recess stenosis with the full-endoscopic interlaminar approach versus conventional microsurgical technique: a prospective, randomized, controlled study

“…15,60,109 Resection of joint and soft-tissue structures in the lateral and ventral area is also and especially required for decompression of degenerative lateral recess stenosis. This is made possible with more tissue-sparing techniques, which are finding increasing use 23,25,27,32,53,67,79,99,117 and are also used in other indications. Technical advances have been made in surgery for disc herniations in the cervical and lumbar spine, which these days enable an FE procedure under continuous irrigation in nearly all cases and can provide the advantages of a truly minimally invasive procedure.…”

“…13,65,81,105,112 The clinical results with the FE technique were equal after 2 years to those obtained with the microsurgical technique and correspond to data reported in the literature. 5,11,[23][24][25]27,32,34,40,[51][52][53]57,67,79,99,113,115 This has been taken as the minimum prerequisite for new techniques. A significant improvement was achieved in the MI and FE groups after 2 years without significant differences.…”