Tubular surgery with the assistance of endoscopic surgery via midline approach for lumbar spinal canal stenosis: a technical note

Matsumura, Yasuo; Nagae, Masateru; Ikeda, Takumi; Tonomura, Hitoshi; Fujiwara, Hiroyoshi; Kubo, Toshikazu

doi:10.1007/s00586-013-2806-5

Cited by 36 publications

(33 citation statements)

References 8 publications

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“…Moreover, curved surgical burs or curved Kerrison rongeurs cannot be inserted. Even when using the conventional 16-mm cylindrical tubular retractor, the level of surgical difficulty is high, [10][11][12][13][14] and only experienced surgeons can use this device competently at present. Therefore, a further increase in surgical difficulty should be avoided.…”

Section: Discussionmentioning

confidence: 99%

Rectangular Tubular Retractor for Microendoscopic Lumbar Decompression

Nakamura¹,

Shibayama²

2016

J Neurol Surg A Cent Eur Neurosurg

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A cylindrical working tube with a diameter of 16 mm has been used for endoscopic posterior lumbar spinal surgery. However, intraoperative muscle resection is significant when using the current conventional tubular retractor. To describe a novel tubular retractor for microendoscopic surgery and to analyze the outcomes of lumbar decompressive laminotomy using this retractor. We devised a novel tubular retractor by changing the medial and lateral sides of the conventional 16-mm cylindrical tubular retractor to planes with a mediolateral dimension of 10 mm (rectangular tubular retractor hereafter). The amount of muscle resection, osteotomy angle on the approach side, and operating time were compared between 25 intervertebral levels treated by bilateral decompression through a unilateral approach using the rectangular tubular retractor and 31 intervertebral levels treated with the same surgery using a 16-mm cylindrical tubular retractor. Due to the short mediolateral dimension, muscle resection decreased by 86%. The rectangular tubular retractor also decreased early postoperative wound pain. Because the craniocaudal dimension of the tubular retractor was maintained, surgical difficulty did not increase, resulting in only a slight increase in operating time. The facet joint on the approach side could be sufficiently preserved. The rectangular tubular retractor reduced surgical invasiveness without increasing surgical difficulty.

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Section: Discussionmentioning

confidence: 99%

Rectangular Tubular Retractor for Microendoscopic Lumbar Decompression

Nakamura¹,

Shibayama²

2016

J Neurol Surg A Cent Eur Neurosurg

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“…16,21,22 From October 2004, treatment was changed to an improved method developed at our department using a midline approach 14 providing a bilateral symmetrical field of view. As a result, 11 cases were treated with a paraspinal approach and 40 with a midline approach.…”

Section: Operative Methodsmentioning

confidence: 99%

“…14 outcome variables Clinical results were determined using Japanese Orthopaedic Association (JOA) Assessment of Treatment for Low Back Pain scores (29-point scale) 5,14 and their improvement rate was examined. The number of reoperated cases and their causes were also examined.…”

Section: Paraspinal Approachmentioning

confidence: 99%

Outcomes in cases of lumbar degenerative spondylolisthesis more than 5 years after treatment with minimally invasive decompression: examination of pre- and postoperative slippage, intervertebral disc changes, and clinical results

Mori¹,

Matsumura²,

Ikeda³

et al. 2016

SPI

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OBJECT There are reports that fusion is the standard treatment of choice for cases of lumbar degenerative spondylolisthesis (LDS) associated with lumbar spinal canal stenosis with a large degree of slippage. The reasons why, however, have not been clarified. On the other hand, it is known that the progress of slippage decreases and restabilization occurs over the natural course of LDS. Therefore, if minimally invasive decompression could be performed, there would be little possibility of it influencing the natural course of LDS, so it would not be necessary to include preoperative percentage slip in the criteria for the selection of fusion. This study examined the course of LDS cases more than 5 years after treatment with minimally invasive decompression to determine whether pre- and postoperative slippage and disc changes influence the clinical results. METHODS A total of 51 intervertebral segments in 51 cases with the chief complaint of radicular or cauda equina symptoms due to lumbar spinal canal stenosis were examined after prospective treatment with minimally invasive decompression for LDS. The mean age of the patients at the time of surgery was 66.7 years and the mean follow-up period was 7 years 4 months. Minimally invasive decompression was performed regardless of the degree of low-back pain or percentage slip. The outcome variables were clinical results and changes in imaging findings. RESULTS Over the follow-up period, postoperative percentage slip increased and disc height decreased, but the Japanese Orthopaedic Association score improved. Regardless of the preoperative percentage slip, disc height, or degree of intervertebral disc degeneration or segmental instability, the clinical results were favorable. In the high preoperative percentage slip group, low disc height group, and progressive disc degeneration group, there was little postoperative progress of slippage. In the group with a postoperative slippage increase of more than 5%, slippage increased significantly at postoperative year 2, but no significant difference was observed at the final follow-up. CONCLUSIONS When minimally invasive decompression was performed to treat LDS, the postoperative change in slippage was no different from that during the natural course. Furthermore, regardless of the degree of preoperative slippage or intervertebral disc degeneration, the clinical results were favorable. Also, the higher the preoperative percentage slip and the more that disc degeneration progressed, the more the progress of postoperative slippage decreased. Because the postoperative progress of slippage decreased, it is believed that even after minimally invasive decompression, restabilization occurs as it would during the natural course. If minimally invasive decompression can be performed to treat LDS, it is believed that preoperative percentage slip and intervertebral disc degeneration do not have to be included in the appropriateness criteria for fusion.

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“…Recently, a minimally invasive technique that has gained popularity over the pastyears is unilateral laminotomy for bilateral decompression(ULBD), the procedure requires aunilateral exposure and muscle retraction, thereby minimizingiatrogenic injury to the paraspinalmusclesandthe spinous process/interspinousligament midline tension band structures [5] (Fig. 1).…”

Section: Introductionmentioning

confidence: 99%

Clinical and radiographic outcomes for microsurgical unilateral laminotomy for bilateral decompression of lumbar spinal stenosis for elderly patients-A retrospective cohort study

Lv¹

2020

Preprint

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BackgroundRecently, unilateral laminotomy for bilateral decompression (ULBD) has become a alternative to conventional decompression for symptomatic lumbar spinal stenosis (LSS),and this minimally invasive surgical technique has shown a satisfactory outcomes and low complications. However, the influence of old age on the risk of postoperative complications and clinical outcome is not well understood.OBJECTIVEThe purpose of this study was to evaluate clinical and radiographic outcomes and complication rates after ULBD in elderly patients.Study DesignSingle center retrospective observational study.SettingAll data was from the affiliated people's hospital of Jiangsu University.METHODSIn this study, 39 elderly patients were treated for lumbar spinal stenosis by ULBD between January 2016 and January 2018. Follow-up consisted of radiologic investigations, Visual Analog Scale, Oswestry Disability Index, and 36-Item Short-Form Health Survey at 6 and 12 months postoperatively. Preoperative comorbidity, postoperative complications and revision surgery rates were also analyzed.RESULTSThere were 12 female patients and 27 male patients with a mean age of 75.83 ± 9.16 years. 20 patients had one levels of spinal stenosis, 13 patients had two levels of stenosis, 6 patients had three levels of stenosis. Average follow-up time was 14.6 ± 7.8 months (range, 6–24 months), Total complications were 10.2%(4/39),and reoperation rate was 2.5%(1/39). Oswestry Disability Index scores decreased significantly (from 32.26 ± 6.82 to 11.44 ± 2.50 at 6 months and 10.56 ± 2.29 at 12 months), and 36-Item Short-Form Health Survey parameter scores demonstrated a significant improvement in the follow-up results.LimitationA multi-center study is recommended to confirm our findings and explore the factors related to clinical and radiographic outcomes.CONCLUSIONSULBD for lumbar spinal stenosis is a safe and effective treatment for elderly patients, improves these patients’ quality of life and does not pose an increased risk of complications.

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Tubular surgery with the assistance of endoscopic surgery via midline approach for lumbar spinal canal stenosis: a technical note

Cited by 36 publications

References 8 publications

Rectangular Tubular Retractor for Microendoscopic Lumbar Decompression

Rectangular Tubular Retractor for Microendoscopic Lumbar Decompression

Outcomes in cases of lumbar degenerative spondylolisthesis more than 5 years after treatment with minimally invasive decompression: examination of pre- and postoperative slippage, intervertebral disc changes, and clinical results

Clinical and radiographic outcomes for microsurgical unilateral laminotomy for bilateral decompression of lumbar spinal stenosis for elderly patients-A retrospective cohort study

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