Percutaneous Endoscopic Unilateral Laminotomy and Bilateral Decompression under 3D Real-Time Image-Guided Navigation for Spinal Stenosis in Degenerative Lumbar Kyphoscoliosis Patient: An Innovative Preliminary Study

Abstract

Background The aim of this study is to report a new method of percutaneous endoscopic decompression under 3D real-time image-guided navigation for spinal stenosis in degenerative kyphoscoliosis patients without instability or those who could not endure major surgery due to multiple comorbidities. Decompression along using endoscope for kyphoscoliosis patient is technical demanding and may result in unnecessary bone destruction leading to further instability. With 3D real-time image-guided navigation, we could improve the accuracy of surgery and maintain the spinal stability as preoperative condition. This is the first study which reports on treating spinal stenosis in patients with degenerative kyphoscoliosis using percutaneous endoscope under 3D real-time image-guided navigation. MethodsIn this study, we presented four cases. All patients were over 70 years old with variable degrees of kyphoscoliosis and multiple comorbidity who could not endure major spine fusion surgery. Percutaneous endoscopic unilateral laminotomy and bilateral decompression under 3D real-time image-guided navigation were successfully performed. Intraoperative photos demonstrating this technique are also provided Results All patients were successfully treated with percutaneous endoscopic laminotomy with under 3D real-time image-guided navigation. Post-operative X ray and MRI were arranged and revealed sufficient decompression without any unnecessary bone destruction. All preoperative neurological symptoms improved postoperatively. There is no surgery-related complication such as inadequate decompression, dural tear, iatrogenic neurological injury, uncontrolled epidural hemorrhage, unnecessary bone destruction with further instability. Conclusions To the best of our knowledge, this is the first preliminary study of percutaneous endoscopic laminotomy under O-arm navigation with successful outcomes. The innovative technique serves as a promising solution in treating spinal stenosis patients with lumbar kyphoscoliosis and multiple comorbidities.