Full-Endoscopic Soft Tissue Approach for Lumbar Disc Herniation

Background Data: Traditionally, lumbar canal stenosis (LCS) has been treated with conventional laminectomy involving wide resection of posterior supporting structures of the lumbar spine such as the supraspinous and inter-spinous ligamentum complex, the spinous process as well as wide areas of the lamina. In addition, this required a large incision of the skin and underlying musculoligamentous complex (posterior tension band). Purpose: The current study focuses on the clinical outcome and utility of minimally invasive microendoscopic decompression from a unilateral approach in surgical management of patients with single and multiple level lumbar canal stenosis. The objective is to describe the indications, significance and applications of endoscopic spine surgery in patients with single and multiple level LCS. Additionally, to highlight important anatomical perspectives of the technique and share surgical experience and results. Study Design: A retrospective clinical case study. Patients and Methods: From May 2008 to January 2016, 583 consecutive patients were treated for LCS and included in this study. Patients' main complaint was bilateral neurogenic claudication in addition to back pain and sciatic neuralgia. Single level decompression was performed in 468 (80%) patients and multiple level decompressions in 115 (20%) patients. Magnetic resonance imaging (MRI), computed tomography (CT) scan and plain X-rays were performed for all patients to confirm evidence of central stenosis and then repeated postoperatively. All patients were followed up for at least 3 months and their data collected. Clinical and functional outcomes were assessed using Visual Analogue Scale (VAS) and the Japanese Orthopedic Association Score (JOA) score for lumbar disease. Results: Compared to preoperative complaint, there was an improvement of back pain in 77.9% of patients and in radiating leg pain in 86.3%. With regards to functional outcomes, median preoperative JOA score was 14.93 ± 0.48 and improved postoperatively to 27.17 ± 1.45 (p < 0.001). The mean operating time per level was 78 minutes, and the mean intraoperative blood loss per level was 18 ml. Complications mainly included dural tears in 27 (4.6%) patients, transient postoperative dysesthesia in 46/583 (7.9%) patients and excess bony work in the form of unintended medial facetectomy in 38/583 (6.5%) patients and fracture of the spinous process in 3 (0.5%) patients.

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Microendoscopic bilateral Decompression via Unilateral Approach in Single and Multiple Level Lumbar Canal Stenosis: A Series of 583 Cases

Kabil

Ebrahim

2017

“…2,29,30,34,42 Only few series 35,37,41 have directly compared open laminotomy with open laminectomy. Several studies 1,2,20,22,31,33,38 have shown benefits of spinal endoscopic fenestration, including decreased blood loss, shorter operative time, shorter hospital duration, decreased postoperative narcotic requirement, decreased rate of infection and CSF leak, and a decrease in time required for returning to work.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Fenestration in Management of Monosegmental Degenerative Lumbar Spinal Canal Stenosis: A Clinical Cohort Study

Hussein

El-Adawy

Elhewala

2019

Background Data: Minimally invasive fenestration has evolved recently to become the modern standard surgical solution for degenerative lumbar spinal canal stenosis (DLCS). Purpose: To investigate the safety and the efficacy of the endoscopic fenestration for patients with monosegmental degenerative lumbar spinal canal stenosis. Study Design: Prospective clinical cohort study. Patients and Methods: Thirty-five consecutive patients with DLCS were treated with endoscopic fenestration. Patients were treated with METRx system (Medtronic Sofamor Danek, Inc., Memphis, TN, USA), at Orthopedic Department, Zagazig University, between May 2012 and June 2015. Primary outcomes parameters included Numerical Rating Scale (NRS) for back and leg symptoms and Oswestry Disability Index (ODI) to quantify pain and disability, respectively. Secondary outcomes parameters included operative time, blood loss, preoperative and 3-month postoperative lumbar dynamic radiographs, and modified McNab criteria. Only patients who completed 36 months of follow-up were included in the final analysis of this study. Follow-up data were obtained from outpatient clinic follow-up visits by two independent physicians. Results: At the final follow-up, the improvement in claudicant leg pain and disability was statistically significant, and the endoscopic fenestration procedure did not affect the stability of the motion segment. The total success rate according to McNab criteria was 85.7% (30/35), fair 5.7% (2/35), and poor 8.6% (3/35). The mean NRS leg score significantly decreased from 7.3±1.5 preoperatively to 0.8±0.67 (P=0.001) postoperatively. The mean ODI score significantly decreased from 72.34±4.6 % preoperatively to 13.71±3.46 % postoperatively. There were no reported serious complications in any of our patients' study. Conclusion: Endoscopic fenestration is a safe and effective technique in patients with degenerative lumbar stenosis. It allows adequate decompression of the neural elements and preserves spinal stability. (2018ESJ145)

“…Minimally invasive surgery can be classified into microscopic, endoscopic and percutaneous procedures. 2,20 Nowadays, "Minimally Invasive Surgery" is a trend setting catchword, but in the seventies the application of microsurgical techniques derived from intracranial procedures to the lumbar spine was a breakthrough. 1 In 1997 Smith and Foley introduced the microendoscopic discectomy (MED) system, which allowed spinal surgeons to decompress a symptomatic lumbar nerve root reliably.…”

Section: Introductionmentioning

confidence: 99%

Comparing the Extent of Tissue Damage between Lumbar Microendoscopic Discectomy (MED) and Microscopic Discectomy (MD) Using Biochemical Markers

Abbas

Elwany

Mohamed

2018

Background Data: Discectomy through a limited laminotomy has remained the "gold standard" for lumbar disc surgery. Surgery for lumbar disc herniation can be classified into two broad categories;open (conventional) versus minimally invasive surgery , where the last category classified into microscopic, endoscopic and percutaneous procedures. Microendoscopic discectomy (MED) is unique in that it combines open surgical principles with endoscopic technology. Purpose: To evaluate extent of tissue damage and pain relief after microendoscopic (MED) and microscopic lumbar discectomy (MD). Study Design: A prospective randomized controlled study. Patients and Methods: The study included 40 patients having lumbar disc prolapse, operated in Alexandria Main University Hospital. Twenty of them underwent MED (Group A) and the other twenty underwent MD (Group B). Clinical (VAS, ODI) and radiological and biochemical markers (CRP, CPK) for tissue inflammation data were collected preoperatively and postoperatively for comparison. Patients were followed up for 6 months. Results: 26 patients were males and 14 were females. The mean age for group A was 40.8±1.34 years and for group B was 40.2±1.06 years. Clinically all patients had low back pain and radicular leg pain. There was no statistically significant difference between the duration of surgery in both groups. The length of hospital stay was significantly less in MED group. The length of the skin wound was significantly less in MED group. Reduction of back pain VAS immediate and 1 month postoperative was reported in both groups and was statistically significantly better in MED group, however, after 6 months there was no difference between both groups. There was significant improvement with no difference between both groups regarding radicular VAS and ODI all through the follow up. Postoperative CRP and CPK was statistically significantly higher in MD group (P<0.001). Conclusion: Both techniques gave comparable clinical outcomes although early back pain score and tissue markers were in favor of MED technique. (2018ESJ153)