Clinical and radiological outcomes of endoscopic partial facetectomy for degenerative lumbar foraminal stenosis

Youn, Myung Soo; Shin, Jong Ki; Goh, Tae Sik; Lee, Jung Sub

doi:10.1007/s00701-017-3186-0

Cited by 20 publications

(10 citation statements)

References 30 publications

(32 reference statements)

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“…We previously reported a microendoscopic technique to decompress the entire length of the nerve root, from the spinal canal to extraforaminal zone, while preserving the posterior elements in LFS patients 6) . Similar techniques with microendoscopy or percutaneous endoscopy for treating LFS have been reported by several authors [7][8][9] . However, during our literature search using PubMed, we found no studies that have assessed the mid-term clinical results of such endoscopic techniques, in spite of their relatively long history.…”

Section: Introductionmentioning

confidence: 56%

Mid-term Clinical Results of Microendoscopic Decompression for Lumbar Foraminal Stenosis

Yoshimoto

Iesato

Terashima

et al. 2019

Spine Surg Relat Res

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Introduction There have been several reports on surgical techniques involving microendoscopy or percutaneous endoscopy for treating lumbar foraminal stenosis (LFS). However, no studies have assessed the mid-term clinical results of endoscopic techniques in spite of their relatively long history. In this study, we report 20 consecutive cases of LFS treated by our microendoscopic technique focusing on clinical results with a follow-up of at least two years. Methods Twenty consecutive cases of LFS treated with microendoscopic decompression were followed up at 1, 2, 6, and 12 months postoperatively and annually thereafter. The patients were 14 males and 6 females, and the mean age at the time of surgery was 64.7 years. The Japanese Orthopaedic Association (JOA) score was used as the clinical outcome index. Results Of the 20 patients, 16 were monitored successfully for more than 2 years. The follow-up rate was 80.0%, and the mean follow-up period was 66.3 months. The JOA score improved from 13.8 points before surgery to 24.6 points at final follow-up. Revision fusion surgeries were performed in two cases for LFS recurrence. Conclusions The microendoscopic technique effectively treats LFS.

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Section: Introductionmentioning

confidence: 56%

Mid-term Clinical Results of Microendoscopic Decompression for Lumbar Foraminal Stenosis

Yoshimoto

Iesato

Terashima

et al. 2019

Spine Surg Relat Res

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“…Kiapour et al 28) reported in the biomechanical study that no instability occurred in graded partial facetectomy, except for total facetectomy. A recent study by Youn et al 29) about one portal endoscopic partial facetectomy supports this theory. All 25 patients who underwent uniportal endoscopic partial facetectomy did not show radiological progression of instability at 2 years of follow-up.…”

Section: Discussionmentioning

confidence: 84%

Clinical and Radiological Outcomes of Foraminal Decompression Using Unilateral Biportal Endoscopic Spine Surgery for Lumbar Foraminal Stenosis

Kim¹,

Choi²,

Park

2018

Clin Orthop Surg

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BackgroundSince open Wiltse approach allows limited visualization for foraminal stenosis leading to an incomplete decompression, we report the short-term clinical and radiological results of unilateral biportal endoscopic foraminal decompression using 0° or 30° endoscopy with better visualization.MethodsWe examined 31 patients that underwent surgery for neurological symptoms due to lumbar foraminal stenosis which was refractory to 6 weeks of conservative treatment. All 31 patients underwent unilateral biportal endoscopic far-lateral decompression (UBEFLD). One portal was used for viewing purpose, and the other was for surgical instruments. Unilateral foraminotomy was performed under guidance of 0° or 30° endoscopy. Clinical outcomes were analyzed using the modified Macnab criteria, Oswestry disability index, and visual analogue scale. Plain radiographs obtained preoperatively and 1 year postoperatively were compared to analyze the intervertebral angle (IVA), dynamic IVA, percentage of slip, dynamic percentage of slip (gap between the percentage of slip on flexion and extension views), slip angle, disc height index (DHI), and foraminal height index (FHI).ResultsThe IVA significantly increased from 6.24° ± 4.27° to 6.96° ± 3.58° at 1 year postoperatively (p = 0.306). The dynamic IVA slightly decreased from 6.27° ± 3.12° to 6.04° ± 2.41°, but the difference was not statistically significant (p = 0.375). The percentage of slip was 3.41% ± 5.24% preoperatively and 6.01% ± 1.43% at 1-year follow-up (p = 0.227), showing no significant difference. The preoperative dynamic percentage of slip was 2.90% ± 3.37%; at 1 year postoperatively, it was 3.13% ± 4.11% (p = 0.720), showing no significant difference. The DHI changed from 34.78% ± 9.54% preoperatively to 35.05% ± 8.83% postoperatively, which was not statistically significant (p = 0.837). In addition, the FHI slightly decreased from 55.15% ± 9.45% preoperatively to 54.56% ± 9.86% postoperatively, but the results were not statistically significant (p = 0.705).ConclusionsUBEFLD using endoscopy showed a satisfactory clinical outcome after 1-year follow-up and did not induce postoperative segmental spinal instability. It could be a feasible alternative to conventional open decompression or fusion surgery for lumbar foraminal stenosis.

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“…Symptomatic foraminal stenosis is thought to cause radiculopathy in approximately 10% of patients suffering from lumbar degenerative spondylosis [17,18]. A decrease in disc height, osteoarthritic degeneration of facet joints, cephalad subluxation of the SAP, buckling of the ligamentum flavum, and protrusion of annulus fibrosus may all contribute to foraminal stenosis [2,17].…”

Section: Discussionmentioning

confidence: 99%

“…To solve these problems, various minimally invasive techniques have been developed. Some authors have reported the use of a technique known as percutaneous endoscopic foraminoplasty [9,18,19]. Previous studies about endoscopic foraminoplasty have shown very promising surgical outcomes not only in the short term, but also in long-term follow-up assessments.…”

Section: Discussionmentioning

confidence: 99%

Biportal Endoscopic Spinal Surgery for Bilateral Lumbar Foraminal Decompression by Switching Surgeon’s Position and Primary 2 Portals: A Report of 2 Cases With Technical Note

Song¹,

Lee

Moon

2019

Neurospine

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Total facetectomy with/without fusion and facet-preserving microforaminotomy have been performed as conventional surgical treatments for lumbar foraminal stenosis (LFS). Recently, endoscopic spinal surgery has been introduced as a minimally invasive therapeutic modality of LFS by several authors. We report two cases of bilateral LFS at lumbosacral junction level successfully treated with a novel biportal endoscopic spine surgery (BES) technique using primary 2 portals. Two patients presented with chronic onset of back pain and neurogenic claudication symptom. They were diagnosed with bilateral LFS at L5–S1 level from magnetic resonance imaging and computed tomography preoperatively. BES for bilateral foraminal decompression was performed via contralateral approach bilaterally without additional skin incision or surgical trajectory by switching surgeon’s position and primary 2 portals. After the surgery, preoperative patients’ back and leg pain resolved and unilateral leg weakness of the 2 patients gradually improved in a few months. Postoperative radiologic images revealed significantly enlarged bilateral foramens at L5–S1 level.

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Clinical and radiological outcomes of endoscopic partial facetectomy for degenerative lumbar foraminal stenosis

Abstract: EPF is an effective option in decompressing the lumbar exiting nerve root without causing spinal instabilities for the treatment of patients with lumbar foraminal stenosis.

Cited by 20 publications

References 30 publications

Mid-term Clinical Results of Microendoscopic Decompression for Lumbar Foraminal Stenosis

Mid-term Clinical Results of Microendoscopic Decompression for Lumbar Foraminal Stenosis

Clinical and Radiological Outcomes of Foraminal Decompression Using Unilateral Biportal Endoscopic Spine Surgery for Lumbar Foraminal Stenosis

Biportal Endoscopic Spinal Surgery for Bilateral Lumbar Foraminal Decompression by Switching Surgeon’s Position and Primary 2 Portals: A Report of 2 Cases With Technical Note

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