Partial undercutting facetectomy for bony entrapment of the lumbar nerve root

Getty, C.J.M.; Johnson, _______; Kirwan, EO; Sullivan, MF

doi:10.1302/0301-620x.63b3.7263743

Cited by 83 publications

(40 citation statements)

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“…Surgical procedures aim to decompress the nerve root emerging from the thecal sac along its course in the lateral recess. A multitude of surgical procedures for surgical decompression of symptomatic lateral recess stenosis have been described ranging from standard open laminectomies to minimally invasive decompressive techniques (14)(15)(16)(17)(18)(19)(20)(21)(22). In the current study we describe the surgical technique of endoscopic interlaminar lateral recess decompression in a small cohort of patients with unilateral symptomatic lateral recess stenosis with well-defined radiographic criteria.…”

Section: Introductionmentioning

confidence: 99%

Interlaminar endoscopic lateral recess decompression—surgical technique and early clinical results

Birjandian¹,

Emerson²,

Telfeian³

et al. 2017

J. Spine Surg.

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Background: Lateral recess stenosis is a common pathology causing de-novo or residual radicular pain following lumbar spine surgery. Diagnostic criteria and treatment strategies for symptomatic lateral recess stenosis are not well established. Methods:We identified ten patients in our prospective patient database (n=146) who underwent endoscopic interlaminar decompression for unilateral symptomatic lateral recess stenosis. Lateral recess height and angle were measured on axial T2-weighted MRI. Values from the symptomatic side were compared to the contralateral side which served as asymptomatic control. Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) for back and leg pain were collected preoperatively, postoperatively and at last follow-up.Results: Preoperative MRI revealed that both lateral recess angle and height were significantly smaller on the symptomatic compared to the asymptomatic side (angle: 19.3˚ vs. 35.7˚; height: 2.9 vs. 5.7 mm; P<0.01).All patients tolerated endoscopic interlaminar decompression well and half of the patients were discharged on the day of surgery. At last follow-up (12.6±1.7 months), 8 out of 10 patients experienced a minimally clinically important improvement of their VAS for ipsilateral leg pain, which improved from 7.2±0.5 preoperatively to 2.5±0.8 postoperatively (P=0.001). The back pain VAS also improved (preoperatively 5.1±1.1 vs. postoperatively 1.7±0.9, P<0.05). The ODI improved from 50±5.8 preoperatively to 22.2±5.1 at last follow-up (P=0.001). One patient experienced persistent leg pain.Conclusions: Lateral recess height and angle correlate with symptomatic lateral recess stenosis which is effectively treated utilizing interlaminar endoscopic lateral recess decompression.

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Section: Introductionmentioning

confidence: 99%

Interlaminar endoscopic lateral recess decompression—surgical technique and early clinical results

Birjandian¹,

Emerson²,

Telfeian³

et al. 2017

J. Spine Surg.

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“…In the Framingham population study, 19-47% of Americans 60 years and older were found to have radiographic evidence of spinal stenosis depending which radiographic criteria were used (1). A multitude of surgical procedures for decompression of lateral recess stenosis have been described ranging from standard open laminectomies to minimally invasive decompressive techniques (2)(3)(4)(5)(6)(7)(8). The goal of these procedures for treating patients experiencing lumbar radicular symptoms secondary to degenerative foraminal narrowing is to expand the stenotic neural foramen relieving the compressed traversing nerve root.…”

Section: Discussionmentioning

confidence: 99%

Contralateral facet-sparing sublaminar endoscopic foraminotomy for the treatment of lumbar lateral recess stenosis: technical note

Krzok¹,

Telfeian

Wagner

et al. 2017

J. Spine Surg.

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Lumbar lateral recess stenosis that results from a degenerative bulging of the disc and overgrowth of the facet is a very common cause for lumbar radiculopathy in the elderly. The standard surgical treatment for symptomatic lumbar lateral recess stenosis often requires a laminectomy or hemi-laminectomy and medial facetectomy which can further destabilize a pathological motion segment. The authors present here a novel technique for contralateral endoscopic access to the lateral recess pathology that is truly minimally invasive and spares most of the facet joint complex: 6 patient cases are described where lateral recess stenosis pathology was accessed from a contralateral sublaminar endoscopic approach.

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“…Considerable disadvantages, such as increased time of surgery and hemorrhage, increased risk of nerve injury by pedicle screws, or postoperative loosening of rigid implants in osteoporotic bone, are connected to this technique. By using the more anatomical, atraumatic, and physiological technique of "undercutting laminectomy", an effective decompression of the spinal canal can be performed while leaving the posterior elements essentially intact [5,6,8,12,29,36]. If fusion is considered necessary, translaminar screws offer an option of fixation with the technique of "undercutting laminectomy" without considerable risk or lengthening of the operation time.…”

Section: Lumbar Spinal Stenosismentioning

confidence: 99%

Translaminar screw fixation in the lumbar spine: technique, indications, results

Grob¹,

Humke²

1998

E Spine J

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IntroductionFixation of the lumbar and lumbosacral spine with pedicle screws is presently the most common technique for internal fixation in the lumbar spine, and has been widely used for a variety of indications for almost 30 years [26,27,35]. However, the use of posterior internal fixation to increase fusion rates was first attempted, to our knowledge, as early as 1891, when a wiring technique for spinal fusion was introduced by Hadra [14]. Reports of various techniques with different implants were published in the following years. The use of facet screws was first reported by King in 1948 [24], whose technique was to immobilize the lumbosacral joints with a short screw, transversing the facet. With his technique, he achieved a fusion rate of 91% without prolonged rigid external fixation postoperatively. Boucher [4a] reported a slightly different technique of screw insertion. He tried to improve the bony purchase by penetrating the ipsilateral pedicle with the tip of the screw. Using this technique, he considerably improved the fusion rate, which he reported as 100% in single-level fusions. However, the tip of the screw had to be placed near the foramen and the nerve root, which carries potential risk of injury.Another modification of the technique of transfixing facets with screws was introduced by Magerl in 1984 [27]. Magerl's idea of inserting the screw from the contralateral side, through the lamina, eliminated the disadvantages of the former techniques without losing their advantages. Bony purchase was increased by the passage of the screw through the lamina, and the procedure is less risky, as (1) the insertion of the screw is clearly posterior to the neural elements and can be performed under direct visual control, and (2) the direction of the screw is parallel to the exiting nerve root.The present review is based on a vast experience covering 15 years of clinical application of translaminar screws. It focuses on the indications, advantages, and contra-indications of this technique.Abstract Translaminar screw fixation of the lumbar spine represents a simple and effective technique for short segment fusion in the degenerative spine. Clinical experience with 173 patients who underwent translaminar screw fixation revealed a fusion rate of 94%. The indications for translaminar screw fixation as a primary fixation procedure are: segmental dysfunction, lumbar spinal stenosis with painful degenerative changes, segmental revision surgery after discectomies, and painful discrelated syndromes such as internal disc disruption and lumbar disc herniation with concomitant degenerative changes. As an additional stabilization procedure, translaminar screws can be used to augment anterior fusion or reinforce pedicle systems. Translaminar screw fixation achieves as high fusion rate provided the biomechanical principles of the lumbar spine with an intact anterior column are respected and a meticulous operative technique is employed to enhance bony ingrowth of the graft.

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Partial undercutting facetectomy for bony entrapment of the lumbar nerve root

Cited by 83 publications

References 0 publications

Interlaminar endoscopic lateral recess decompression—surgical technique and early clinical results

Interlaminar endoscopic lateral recess decompression—surgical technique and early clinical results

Contralateral facet-sparing sublaminar endoscopic foraminotomy for the treatment of lumbar lateral recess stenosis: technical note

Translaminar screw fixation in the lumbar spine: technique, indications, results

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