Percutaneous transforaminal full endoscopic decompression for the treatment of lumbar spinal stenosis

Abstract

Background: One advantage of an endoscopic approach to treating lumbar spinal stenosis is preservation of spine stability and the adjacent anatomy, and there is a decrease in adjacent segment disc degeneration. The purpose of this study was to discuss the clinical efficacy of percutaneous transforaminal endoscopic decompression for the treatment of lumbar spinal stenosis (LSS). Methods: This is a retrospective study. From September 2012 to June 2017, 45 patients who were diagnosed with LSS underwent the treatment of percutaneous transforaminal endoscopic decompression (PTED) and were followed up at 1 week, 3 months and 1 year postoperatively. Low back pain and leg pain were measured by Visual Analogue Scale scoring methods (VAS-back and VAS-leg), while functional outcomes were assessed by using the Oswestry Disability Index (ODI). All patients had one-level lumbar spinal stenosis. Results: The most common type of stenosis was lateral recess stenosis (n = 22; 48.9%), followed by central stenosis (n = 13; 28.9%) and foraminal stenosis (n = 10: 22.2%). Regarding comparisons of VAS-back, VAS-leg, and ODI scores before and after operation, VAS and ODI scores significantly improved. The average leg VAS score improved from 7.01 ± 0.84 to 2.28 ± 1.43 (P < 0.001). The average ODI improved from 46.18 ± 10.11 to 14.40 ± 9.59 (P < 0.001). We also examined changes in ODI and VAS scores from baseline according to types of spinal stenosis, stenosis grade, spinal instability, and revision surgery in the same segment. The improvement percentage of leg VAS score was significantly less in patients with severe stenosis at both 3 months and 1 year postoperatively. The improvement percentages of ODI and leg VAS scores were significantly less in patients who had spinal instability and patients who had undergone revision surgery. Conclusion: The PTED approach seems to give good results for the treatment of LSS. However, this approach may be less effective for LSS patients who have lumbar instability or require revision surgery in the same segment.

Full-Endoscopic Ventral Facetectomy vs Open Laminectomy for Lumbar Lateral Recess Stenosis: A Comparative Study and Brief Literature Review

“…4 Auspicious outcomes of TFES in LRS as well as in other anatomic types of LSS as CS and FS were also verified from later clinical studies. 22,23 Appropriate technical modifications regarding foraminoplasty in FEVF procedure may be associated with ameliorated outcomes in patients with LRS. 24 FEVF implementation in elderly individuals with LRS should be distinctly theorized, concerning its executively great incidence in this patient subpopulation.…”

Finite Element Analysis and in Vitro Biomechanical Experiment on the Effect of Unilateral Partial Facetectomy Performed by Percutaneous Endoscopy on the Stability of Lumbar Spine

“…The experiments performed in previous works were mostly resection of the superior FJ from the dorsal side to the ventral side, which is not in agreement with what is performed in clinical practice, and the cutting method was a longitudinal cut of arti cial division [16,[37][38][39][40][41]. Indeed, a trephine is used in clinical practice to perform a cut from the ventral side of the superior FJ to the dorsal side, and from the head to the tail end [42][43][44]. The resected superior FJ is left with an arc-shaped gap.…”

Comparison of endoscopic and open methods of surgical treatment for lumbosacral spinal canal stenosis: a systematic literature review

“…Основными преимуществами эндоскопического подхода к лечению стеноза поясничного отдела позвоночного канала являются сохранение осевой стабильности позвоночника и минимальное травмирование прилегающих тканей, а также уменьшение дегенерации диска соседнего позвоночного сегмента. Использование чрескожной трансфораминальной эндоскопической декомпрессии при этой патологии показало очень хорошие клинические результаты в целом ряде спинальных хирургических клиник [47,48].…”