Percutaneous Endoscopic Lumbar Foraminoplasty for Lumbar Foraminal Stenosis of Elderly Patients with Unilateral Radiculopathy: Radiographic Changes in Magnetic Resonance Images

Abstract

Background and Study Aims/Objective Clinical outcomes of percutaneous endoscopic lumbar foraminoplasty (PELF) performed for lumbar foraminal stenosis (LFS) have been reported in the literature. However, no study has reported the radiographic changes in magnetic resonance imaging (MRI) after surgery. This report presents the clinical outcome as well as radiographic changes in MRI after PELF for elderly patients with unilateral radiculopathy. We also describe detailed operative nuances to expand the foraminal space and mobilize the affected nerve root. Material and Methods Between January 2015 and December 2016, 24 patients over 65 years of age underwent PELF to treat unilateral radiculopathy caused by LFS. The demographics, medical history, visual analog scale (VAS), and Oswestry Disability Index (ODI) were reviewed retrospectively. MRI radiographic data, cross-sectional area (CSA) of the affected foramen and nerve root, were evaluated before and after surgery. Results Preoperative radiculopathy improved in 23 of 24 patients (96%). The VAS score significantly improved from 7.89 ± 1.8 to 2.57 ± 2.5 (67.4%). The ODI also significantly improved from 33.15 ± 9.2 to 10.24 ± 6.7 (69.1%). Foraminal width increased ∼ 1.67 mm (21.4%), foraminal height increased 5.00 mm (36.9%), and CSA increased about 55.27 mm2 (60.6%) (p < 0.001). The CSA and the shape of the affected nerve section also expanded, but these were not statistically significant. Conclusion We performed PELF in elderly patients with LFS. There were considerable radiographic changes in MRI, and the patients also showed clinically relevant improvement. Thus PELF resulted in sufficient decompression of the nerve root in LFS.

Efficacy and safety for combination of trephine with a new tool in foraminoplasty in percutaneous endoscopic transforaminal discectomy: a retrospective study

“…For patients with migrated or sequestered disc, lateral recess or foramen stenosis, the "inside-out" technique encountered great di culty [17]. According to imaging studies, foraminoplasty can improve cross-section area of foramen considerably [18,19]. Therefore, foraminoplasty is regarded as a critical technique in transforaminal approach, generating enough and safe space for working cannula and endoscopy by enlarging foramen, and then facilitating to perform exiting nerve decompression and epidural space exploration [15,[20][21][22].…”

Residual leg numbness after endoscopic discectomy treatment of lumbar disc herniation

“…Foraminoplasty was performed when disc herniation at L5/S1 level (Fig. 2), which removed small portions of anterolateral bone of facet articulation and its attached ligamentum flavum without interrupting the facet joint space, provided enough working space [31,32]. A gentle hammering and twisting motion of the trephine removed anterolateral bony portions of the facet join.…”

One Percutaneous Portal Endoscopic Discectomy in the Treatment of Two-Level Lumbar Disc Herniations Patients with Leg Pain and Numbness

“…Since the surgery is done under local anesthesia, the surgeon has complete communication with the patient in procedures, by checking the movements of the affected limb and patient complaining sudden and severe radicular pain during the procedure. Foraminoplasty was performed when disc herniation at L5/S1 level, which removed small portions of anterolateral bone of facet articulation and its attached ligamentum avum without interrupting the facet joint space, provided enough working space [32,33].…”