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

Abstract

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.

SPINE: High heterogeneity and no significant differences in clinical outcomes of endoscopic foraminotomy vs fusion for lumbar foraminal stenosis: a meta-analysis

“…The titles and abstracts of the remaining 561 references were screened, and 506 were excluded because they did not meet the inclusion criteria. The remaining 55 articles underwent full-text screening, of which a further 28 articles were excluded because 17 ( 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ) were on patients with foraminal stenosis and an excluded indication, 4 ( 26 , 27 , 28 , 29 ) were on open decompression, 3 ( 30 , 31 , 32 ) reported no outcomes of interest, 2 ( 33 , 34 ) were letters to editors or surgical technique notes, 1 ( 35 ) was on foraminal stenosis secondary to fusion surgery, and 1 ( 36 ) was on a combination of 2 or more procedures. A further four articles were excluded because one ( 37 ) was on a subset of a larger cohort ( 38 ), and three ( 39 , 40 , 41 ) presented the outcomes of interest graphically or as net changes but did not present specific postoperative values (the authors were contacted at least three times but none responded).…”

Comparative Study of the Differences in Radiologic Results for Percutaneous Endoscopic Lumbar Foraminotomy and Microscopic or Micro-endoscopic Lumbar Foraminotomy

“…Ahn et al [4] described a PELF and reported that 91% of the patients achieved good or excellent outcomes using the Oswestry disability index. Yoshimoto et al [13] also reported that foraminal decompression alone had good outcomes, potentially eliminating the need for fusion surgery. Although the present study demonstrated that operation time per neuroforamen and intraoperative blood loss showed no significant difference between the 2 groups, the percutaneous endoscopic technique preserves the muscles and spinal structures, with patients of this technique recovering faster than those who undergo surgery using the conventional techniques [14].…”

Microendoscopic Lumbar Posterior Decompression Surgery for Lumbar Spinal Stenosis: Literature Review

“…The identification of the nerve root is easier in the medial part than in the lateral part of the surgical field because the nerve root runs anteriorly in the lateral part. Additional resection of the caudal part of the upper pedicle is necessary for patients with up-down stenosis ( Figure 5 b), and resection of the ligamentum flavum and/or cranial part of the superior articular process of the lower vertebra may be necessary for those with front-back stenosis at the foramen [ 25 ]. However, a biomechanical study revealed that, to prevent postoperative instability, no more than 50% of the lateral part of the facet and/or pars interarticularis should be removed [ 26 ].…”

“…Revision surgery was required in two cases (6.3%) because of residual stenosis in the foramen. Yoshimoto et al [ 25 ] reported midterm clinical outcomes, with an average follow-up of 66.3 months. Their reports included two cases each of L4/5 and L5/6 foraminal stenosis in addition to 16 cases of L5/S1 foraminal stenosis, and the mean recovery rate of the JOA score was 63.9% at the final follow-up.…”