Microscopy-assisted interspinous tubular approach for lumbar spinal stenosis

Soriano-Sánchez, José-Antonio; Quillo-Olvera, Javier; Soriano-Solis, Sergio; Soriano-Lopez, Miroslava-Elizabeth; Covarrubias-Rosas, Claudia-Angélica; Quillo-Reséndiz, Javier; Gutiérrez-Partida, Carlos-Francisco; Rodríguez-García, Manuel

doi:10.21037/jss.2017.02.07

Cited by 7 publications

(1 citation statement)

References 13 publications

(11 reference statements)

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“…[1][2][3][4][5] Minimally invasive techniques have become mainstream in spinal surgery due to technological advances, such as retractors designed for intermuscular plane mini-open incisional exposures [6][7][8] or tubular access retractors, which in the case of lumbar spinal endoscopy have been further miniaturized into working cannulas just large enough to accommodate an endoscope. [9][10][11][12][13] Less approach-related access trauma and reduced surgical pain in combination with an overall push by patients, insurance providers, and governmental review boards to transition simple lumbar decompression surgeries into a more cost-effective outpatient setting have facilitated a substantial increase of these types of procedures being carried out in an ambulatory surgery center (ASC).…”

Section: Introductionmentioning

confidence: 99%

Readmissions After Outpatient Transforaminal Decompression for Lumbar Foraminal and Lateral Recess Stenosis

Lewandrowski

2018

Int J Spine Surg

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Background: The objective of this study was to analyze readmission rates after outpatient transforaminal endoscopic decompression surgery for lumbar foraminal and lateral recess stenosis done in an ambulatory surgery center. Endoscopic lumbar spinal surgery is gaining popularity for the treatment of lumbar disc herniations. Recent advances in surgical techniques allow for percutaneous endoscopically assisted bony decompression for neurogenic claudication symptoms due to spinal stenosis. The surgery can be done under local anesthesia and sedation. Patients may be discharged home within hours from surgery, and complications are rare. However, readmissions for recurrent disc herniations, failure of pain relief, dysesthetic leg pain, nerve root injuries with foot drop, and facet and pedicle fractures have been reported.Methods: A retrospective study of 1839 consecutive patients with an average mean follow up of 33 months (range 24 to 85 months) that underwent percutaneous endoscopic surgery at 2076 levels between 2006 and 2015 was conducted with the intent of identifying factors associated with emergency room or hospital readmission following endoscopic foraminotomy and microdiscectomy. Only patients with unilateral radiculopathy due to either herniated disc or lateral recess stenosis were included in this study. Preoperatively, disc migration was graded by direction and distance from the disc space according to Lee's radiologic 4-zone classification. The type of disc herniation was classified either as extruded or contained. Contained herniations were further subclassified as disc protrusions versus disc bulges. In addition, the preoperative disc height was recorded. Bony spinal foraminal stenosis and lateral recess stenosis were graded on preoperative magnetic resonance imaging and computed tomography scans into mild, moderate, and severe by dividing the lumbar neuroforamen into 3 zones: (a) entry zone, (b) midzone, and (c) exit zone. Surgical outcomes were classified according to the Macnab criteria. In addition, reduction in visual analog scores (VASs) were assessed. The treating physician (KUL) performed all surgeries.Results: According to the Macnab criteria, excellent and good results were obtained in 82.2% of patients with extruded disc fragment (331/1839). In this group, the mean VAS decreased from 5.9 6 2.5 preoperatively to 2.4 6 1.8 at the final follow up (P , .01). Patients with contained disc herniations (648/1839) had excellent and good results 72.7% of the time. In this group, the mean VAS decreased from 7.2 6 1.6 preoperatively to 3.1 6 1.5 at the final follow up (P , .01). In the spinal stenosis group (860/1839), 75% of patients had excellent to good results. There were no major approach-related complications. Sixty-nine patients had extravasations of irrigation fluid into the subcutaneous tissues (3.8%). Eight patients developed spinal headaches (0.4%). Two patients developed foot drop on the surgical side immediately postoperatively (0.1%). Reherniations of extruded discs occurred in 9 pa...

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Section: Introductionmentioning

confidence: 99%

Readmissions After Outpatient Transforaminal Decompression for Lumbar Foraminal and Lateral Recess Stenosis

Lewandrowski

2018

Int J Spine Surg

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Successful outcome after outpatient transforaminal decompression for lumbar foraminal and lateral recess stenosis: The positive predictive value of diagnostic epidural steroid injection

Lewandrowski

2018

Clinical Neurology and Neurosurgery

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Clinical comparison of unilateral biportal endoscopic transforaminal lumbar interbody fusion verse 3D microscope-assisted transforaminal lumbar interbody fusion in the treatment of single-segment lumbar spondylolisthesis with lumbar spinal stenosis: a retrospective study with 24-month follow-up

Guo,

Li,

Feng

et al. 2023

J Orthop Surg Res

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Objective To explore the safety and the mid-term efficacy of unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF) and 3D microscope-assisted transforaminal lumbar interbody fusion (MMIS-TLIF) for treating single-segment lumbar spondylolisthesis with lumbar spinal stenosis (DLS-LSS). Methods The clinical data of 49 patients who underwent UBE-TLIF or MMIS-TLIF in our hospital were retrospectively analyzed, including 26 patients who underwent the UBE-TLIF and 23 patients who underwent the MMIS-TLIF. The demographic and perioperative outcomes of patients before and after surgery were reviewed. Visual analogue scale (VAS) and Oswestry disability index (ODI) were used to evaluate the clinical outcomes of patients before surgery and at 1, 3, 6, 12 and 24 months after surgery. The lumbar lordosis angle (LL), disc height (DH) and lumbar intervertebral fusion rate were assessed before surgery and at the last follow-up. Results The VAS and ODI scores of the two groups were improved compared with those before surgery. The ODI of UBE-TLIF group was lower than that of MMIS-TLIF group at 1, 3, 6, and 12 months after surgery, and there were no significant differences between the two groups at other time points (P > 0.05). There were no significant differences in VAS between the two groups at each time point (P > 0.05). However, the UBE-TLIF group had more advantages in blood loss and hospital stay. The complications between the UBE-TLIF group (11.54%) and the MMIS-TLIF group (17.39%) were comparable (P > 0.05). Radiographic outcomes showed that the LL and DH of the two groups were improved compared with those before surgery, and the difference before and after surgery was not significant (P > 0.05). The fusion rate was 96.2% in the UBE-TLIF group and 95.7% in the MMIS-TLIF group. There was no significant difference in the fusion rate between the two groups (P > 0.05). Conclusions Both UBE-TLIF and MMIS-TLIF have favorable outcomes for treating single-segment DLS-LSS. Both groups have the advantages of clear surgical vision, high surgical efficiency, and favorable mid-term efficacy. In addition, compared with MMIS-TLIF, UBE-TLIF causes less intraoperative bleeding and faster postoperative recovery.

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Microscopy-assisted interspinous tubular approach for lumbar spinal stenosis

Cited by 7 publications

References 13 publications

Readmissions After Outpatient Transforaminal Decompression for Lumbar Foraminal and Lateral Recess Stenosis

Readmissions After Outpatient Transforaminal Decompression for Lumbar Foraminal and Lateral Recess Stenosis

Successful outcome after outpatient transforaminal decompression for lumbar foraminal and lateral recess stenosis: The positive predictive value of diagnostic epidural steroid injection

Clinical comparison of unilateral biportal endoscopic transforaminal lumbar interbody fusion verse 3D microscope-assisted transforaminal lumbar interbody fusion in the treatment of single-segment lumbar spondylolisthesis with lumbar spinal stenosis: a retrospective study with 24-month follow-up

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