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

Abstract

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.

Efficacy of the Unilateral Uniportal Endoscopic Approach in Management of Monosegmental Lumbar Canal Stenosis

“…26,42 However, this duration of hospital stay was less than that reported by Khoo and Fessler 14 (42 hours) and Lee et al 18 , whereas it was more than that presented by Rahman et al 26 (18 hours). The mean operating time per level was similar to that of Xu et al 41 , Pao et al 24 , and Wada et al 38 On the other hand, Khoo and Fesler 14 , Lee et al 18 , Kabil et al 12 22 , the mean operating time per level was 66.1 minutes (range, . The lower mean time might be attributed to the higher number of levels operated (753) and the more experience of the surgeon.…”

“…Follow-up: Patients were followed up routinely at our outpatient clinic at 2 weeks, 3 months, 6 months, and 12 months. The mean follow-up was 10.5 ± 2.3 months (range, [6][7][8][9][10][11][12]. The assessment included clinical evaluation using NPRS and ODI.…”

Sublaminar Decompression and Fusion in the Management of Stenotic Lumbar Degenerative Disorders

“…A large retrospective study using micro-endoscopic decompression for management of 583 patients with lumbar canal stenosis, in which mean leg pain VAS improved from 8 preoperatively to 2 postoperatively. 4 In another study, 2 patients with degenerative lumbar canal stenosis have undergone bilateral decompression from unilateral approach, the VAS improved from 7±0.72 preoperatively to 2±0.72 postoperatively.…”

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

“…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.…”

“…Another shortcoming is the absence of a controlled group that would have suboptimal outcomes proven in the literature by several studies. 16,18,20,41 We did not like to offer our patients a procedure we believe would be suboptimal and not up to date. However, a 36-month follow-up that allowed observation of persistence of the initial good out-come and the prospective nature, the homogeneity of patient population, and the independent observers are strengths points of the current study.…”