Feasibility of Unilateral Approach for Bilateral Decompressive Endoscopic Spinal Surgery for Lumbar Stenosis to Improve Back and Leg Pain: A Consecutive Single-Center Series of 60 Patients

Abstract

Introduction: Endoscopic surgery is one of the methods that achieve the goal of decompression while minimizing collateral tissue damage. Its efficacy and safety have been supported by numerous studies. There is a plethora of studies on lumbar stenosis regarding the outcomes and related issues in endoscopic spine surgery. However, few studies evaluated the outcome of the decompressive lumbar spine surgery. The present study aims to analyze the outcome of a unilateral approach to endoscopic surgery for lumbar stenosis using the visual analog scale (VAS), the Oswestry Disability Index (ODI), and MacNab's criteria.Methods: This is a retrospective study (level IV) conducted between January 2009 and December 2013 on 60 patients who underwent endoscopic interlaminar decompressive spine surgery (Destandau method) for lumbar degenerative spinal stenosis in the Hospital Universiti Sains Malaysia. The clinical outcome was measured pre-operatively and post-operatively for VAS: for back and leg pain, motor and sensory grading, the ODI, and MacNab's criteria. A paired t-test was used for statistical analysis.Results: The mean age of patients was 60.82 years comprising 23 males (38.3%) and 37 females (61.7%). The mean follow-up period was 30.1 months (range = 17.2–43 months). The mean operation time was 183.6 min (ranging from 124.8 to 242.4 min), and the mean blood loss was 150.18 mL (ranging from 30.82 to 269.54 mL). Post-operatively, mean hospital stay was 2.45 days (ranging from 1.34 to 3.56 days). The most frequently involved level was L4/L5 in 51 patients (52.6%), followed by L3/L4 in 19 patients (19.6%), L5/S1 in 24 patients (24.7%), and L2/L3 in three patients (3.1%). Improvement in the post-operative VAS for back and leg pain and the ODI for pre-operation and post-operation was statistically significant (p < 0.001). Conversely, the reduction in neurological status was statistically insignificant. Based on MacNab's criteria, 88.4% showed excellent to good outcomes.Conclusion: To summarize, unilateral percutaneous endoscopic spine surgery to achieve the bilateral decompression in lumbar stenosis provides excellent yet safe and effective outcomes. It improves back and leg pain and patients' function significantly.

Evaluation of the efficacy and safety of conventional and interlaminar full-endoscopic decompressive laminectomy to treat lumbar spinal stenosis (ENDO-F trial): Protocol for a prospective, randomized, multicenter trial

“…Previous studies have reported that clinical outcomes of interlaminar full-endoscopic laminectomy are not different from those of conventional laminectomy [ 13 – 15 , 19 – 22 ]. However, the previous studies are limited by their retrospective or single-center designs [ 4 , 13 – 15 , 20 , 21 , 23 – 25 ]. In this trial, the quality of the evidence will be improved as adequate sample sizes, blinded assessments, and prospective registration from multiple centers will be used to reduce bias.…”

“…Previous studies have reported that the clinical outcomes of interlaminar full-endoscopic laminectomy are not different from those of conventional laminectomy [ 13 – 15 , 19 – 22 ]. However, all previous studies comparing interlaminar full-endoscopic laminectomy and conventional open laminectomy are retrospective or single-center prospective studies [ 4 , 13 – 15 , 20 , 21 , 23 – 25 ]; therefore, a multicenter, randomized controlled trial (RCT) is needed.…”

Lumbar Endoscopic Unilateral Laminotomy With Bilateral Decompression Surgery in Severe Lumbar Stenosis Under Electrophysiological Monitoring-Focused on Full-Visualized Trephine/Osteotome

“…Endoscopic spine surgery has been evolving rapidly in the past decades, starting from contraindications and eventually becomes feasible for lumbar stenosis. Due to the wide range of treatable lumbar stenosis and the reported favorable clinical outcomes, the endoscopic posterior approach has attracted more and more attention [ 17 - 22 ].…”

“…Due to the wide range of treatable lumbar stenosis and the reported favorable clinical outcomes, the endoscopic posterior approach has attracted more and more attention. [17][18][19][20][21][22] As we all know, the outside-in technique was most accepted in the LE-ULBD surgery, 23 whose procedure involves removal of bony structure including the lamina, articular facet joint first, then the entire LF en bloc or piecemeal to expose the dura and nerve root. However, the outside-in technique has disadvantages including uncertain removal border, dura tear and nerve injury.…”

What’s New in Spine Surgery

“…Using the MacNab criteria, 88.4% showed excellent to good outcomes. A unilateral percutaneous endoscopic approach to perform bilateral decompression for patients with lumbar stenosis is both safe and effective 8 .…”