Minimally Invasive Foraminotomy Through Tubular Retractors via a Contralateral Approach in Patients With Unilateral Radiculopathy

Alimi, Marjan; Njoku, Innocent; Cong, Guang‐Ting; Pyo, Se Young; Hofstetter, Christoph P.; Grunert, Peter; Härtl, Roger

doi:10.1227/neu.0000000000000358

Cited by 33 publications

(21 citation statements)

References 35 publications

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“… 2) Several studies with low revision rates after decompression-alone procedure included many fewer cases with L5/S LFS than the present study. 6 , 18 , 19) The dorsal root ganglion/foraminal height ratio becomes maximum at the intraforaminal area of L5/S, 20) as the mobility of L5 nerve root is limited by a large L5/S facet joint, iliolumbar ligament, and sacral ala in the extraforaminal area. 21 , 22) These anatomical features increase the incidence of symptomatic LFS at L5/S as well as the recurrence rate after MFD.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Radiological Outcomes of Microscopic Lumbar Foraminal Decompression: A Pilot Analysis of Possible Risk Factors for Restenosis

Haimoto

Nishimura

Hara

et al. 2018

Neurol. Med. Chir.(Tokyo)

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A single-center retrospective comparative study was designed to identify the risk factors for restenosis of lumbar foraminal stenosis (LFS) after microscopic foraminal decompression (MFD). 21 consecutive patients who underwent single-level MFD with an average of 19-month follow-up were divided into two study groups based on clinical outcomes; group 1 (7 patients with poor outcomes requiring revision surgery), group 2 (14 patients with good outcomes with no revision surgery required). Changes of lumbar spinal alignment on plain standing radiographs were compared and analyzed between two study groups to investigate the pathology and risk factors associated with restenosis after MFD. Preoperative disc wedging (DW) angle was significantly larger in group 1 than in group 2 (3.5 ± 1.0° vs 1.1 ± 0.2°, P < 0.01). Postoperatively, disc height (DH) and foraminal height (FH) decreased (P < 0.05), and DW deteriorated (P < 0.01) significantly in group 1, while there were no significant changes in group 2. Lumbar lordosis (LL) remarkably improved postoperatively in group 2 (24.7 ± 8.0 to 32.0 ± 7.0, P < 0.001), contrary to limited improvement in group 1 (25.1 ± 9.2 to 27.0 ± 12.0, P = 0.45). Postoperative LL is a predictive factor for restenosis after MFD. Decrease in DH or progression of DW was contributing to restenosis. LFS presenting with large DW and lumbar degenerative kyphosis should be excluded from surgical indications for MFD without instrumented fusion, considering the high recurrence rate.

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Section: Discussionmentioning

confidence: 99%

Clinical and Radiological Outcomes of Microscopic Lumbar Foraminal Decompression: A Pilot Analysis of Possible Risk Factors for Restenosis

Haimoto

Nishimura

Hara

et al. 2018

Neurol. Med. Chir.(Tokyo)

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“…However, in cases where central stenosis is associated with significant and symptomatic unilateral foraminal stenosis, a contralateral approach may be preferable because it affords excellent visualization of the contralateral foramen [44].…”

Section: Discussion Backgroundmentioning

confidence: 99%

Unilateral tubular approach for bilateral laminotomy: effect on ipsilateral and contralateral buttock and leg pain

et al. 2016

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“…Alimi et al 40 reported the results of a unilateral minimally invasive lumbar foraminotomy through tubular retractors via a contralateral epidural approach for unilaterally dominant radiculopathy arising as a consequence of root compression. In a 12 month follow up of 32 patients they reported excellent functional outcome in 95% with one patient requiring revision by fusion.…”

Section: Discussionmentioning

confidence: 99%

Transforaminal Endoscopic Lumbar Decompression & Foraminoplasty: A 10 Year prospective survivability outcome study of the treatment of foraminal stenosis and failed back surgery

Knight

Jago

Norris³

et al. 2014

Int J Spine Surg

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BackgroundConventional diagnosis between axial and foraminal stenosis is suboptimal and long-term outcomes limited to posterior decompression. Aware state Transforaminal Endoscopic Lumbar Decompression and Foraminoplasty (TELDF) offers a direct aware state means of localizing and treating neuro-claudicant back pain, referred pain and weakness associated with stenosis failing to respond to conventional rehabilitation, pain management or surgery. This prospective survivability study examines the outcomes 10 years after TELDF in patients with foraminal stenosis arising from degeneration or failed back surgery.MethodsFor 10 years prospective data were collected on 114 consecutive patients with multilevel spondylosis and neuro-claudicant back pain, referred pain and weakness with or without failed back surgery whose symptoms had failed to respond to conventional rehabilitation and pain management and who underwent TELDF. The level responsible for the predominant presenting symptoms of foraminal stenosis, determined on clinical grounds, MRI and or CT scans, was confirmed by transforaminal probing and discography. Patients underwent TELDF at the spinal segment at which the predominant presenting symptoms were reproduced. Those that required treatment at an additional segment were excluded. Outcomes were assessed by postal questionnaire with failures being examined by the independent authors using the Visual Analogue Pain Scale (VAPS), the Oswestry Disability Index (ODI) and the Prolo Activity Score.ResultsCohort integrity was 69%. 79 patients were available for evaluation after removal of the deceased (12), untraceable (17) and decliners (6) from the cohort.VAP scores improved from a pre-operative mean of 7.3 to 2.4 at year 10. The ODI improved from a mean of 58.5 at baseline to 17.5 at year 10. 72% of reviewed patients fulfilled the definition of an “Excellent” or “Good Clinical Impact” at review using the Spinal Foundation Outcome Score. Based on the Prolo scale, 61 patients (77%) were able to return and continue in full or part-time work or retirement activity post-TELDF. Complications of TELDF were limited to transient nerve irritation, which affected 19% of the cohort for 2 – 4 weeks. TELDF was equally beneficial in those with failed back surgery.ConclusionsTELDF is a beneficial intervention for the long-term treatment of severely disabled patients with neuro-claudicant symptoms arising from spinal or foraminal stenosis with a dural diameter of more than 3mm, who have failed to respond to conventional rehabilitation or chronic pain management. It results in considerable improvements in symptoms and function sustained 10 years later despite co-morbidity, ageing or the presence of failed back surgery.Clinical RelevanceThe long term outcome of TELDF in severely disabled patients with neuro-claudicant symptoms arising from foraminal stenosis which had failed to respond to conventional rehabilitation, surgery or chronic pain management suggests that foraminal pathology is a major cause of lumbar axial and referred pain ...

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Minimally Invasive Foraminotomy Through Tubular Retractors via a Contralateral Approach in Patients With Unilateral Radiculopathy

Abstract: A minimally invasive, facet-sparing contralateral approach is an effective technique for treatment of radiculopathy due to foraminal compression. It also allows for decompression of lumbar spinal stenosis and bilateral lateral recess decompression without the need for fusion.

Cited by 33 publications

References 35 publications

Clinical and Radiological Outcomes of Microscopic Lumbar Foraminal Decompression: A Pilot Analysis of Possible Risk Factors for Restenosis

Clinical and Radiological Outcomes of Microscopic Lumbar Foraminal Decompression: A Pilot Analysis of Possible Risk Factors for Restenosis

Unilateral tubular approach for bilateral laminotomy: effect on ipsilateral and contralateral buttock and leg pain

Transforaminal Endoscopic Lumbar Decompression & Foraminoplasty: A 10 Year prospective survivability outcome study of the treatment of foraminal stenosis and failed back surgery

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