The VAS score and ODI significantly improved after SELD in herniated nucleus pulposus (HNP) patients with LBP and radiculopathy. Postoperative MRI showed a notable decrease in the HNP size and a reduction in neural compression. SELD is suggested to be an effective therapeutic modality for patients with symptomatic HNP.
Study Design
This retrospective study involved 450 consecutive cases of degenerative lumbar stenosis treated with percutaneous stenoscopic lumbar decompression (PSLD).
Purpose
We determined the feasibility of PSLD for lumbar stenosis at single and multiple levels (minimum 1-year follow-up) by image analysis to observe postoperative widening of the vertebral canal in the area.
Overview of Literature
The decision not to perform an endoscopic decompression might be due to the surgeon being uncomfortable with conventional microscopic decompression or unfamiliar with endoscopic techniques or the unavailability of relevant surgical tools to completely decompress the spinal stenosis.
Methods
The decompressed canal was compared between preoperative controls and postoperative treated cases. Data on operative results, including length of stay, operative time, and surgical complications, were analyzed. Patients were assessed clinically on the basis of the Visual Analog Scale (VAS) score for the back and legs and using the Oswestry Disability Index (ODI).
Results
Postoperative magnetic resonance imaging revealed that PSLD increased the canal cross-sectional area by 52.0% compared with the preoperative area at the index segment (
p
<0.001) and demonstrated minimal damage to the normal soft tissues including muscles and the extent of removed normal bony tissues. Mean improvements in VAS score and ODI were 4.0 (
p
<0.001) and 40% (
p
<0.001), respectively.
Conclusions
PSLD could be an alternative to microscopic or microendoscopic decompression with various advantages in the surgical management of lumbar stenosis.
Although lumbar stenosis was recognized as a contraindication for endoscopic spine surgery in the past, the advancement in endoscopic system design and development of approach techniques and strategies now enabled the endoscopic spine surgeons to manage all types of lumbar stenosis safely and more effectively. A full-endoscopic lumbar technique for surgical management of spinal canal stenosis is now used today in many advanced spine centers around the world as one of their standard procedures which can be done under general, regional, local anesthesia with sedation. In this technical report, we described in detail the inside-out approach of performing lumbar endoscopic unilateral laminotomy with bilateral decompression (LE-ULBD) and retrospectively reviewed hospital records of 127 patients who underwent the approach from December 2018 to March 2019 to address 1 level lumbar spinal stenosis and determined its outcome after 12-month follow-up period. Perioperative outcomes, operation time, length of hospital stay, and surgical complications were recorded and analyzed. The cross-sectional area of the thecal sac at the operated level was measured. The visual analogue scale (VAS) was assessed preoperatively, 1 month, and 12 months as well as the Oswestry Disability Index (ODI). The data were statistically analyzed (using SPSS ver. 17.0). The inside-out approach LE-ULBD was shown to effect statistically significant improvement in the VAS of leg and back pain as well as the ODI. It is a familiar, safe, and effective way of performing spinal stenosis decompression with good reproducible outcomes.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.