Percutaneous Total Endoscopic Resection of Partial Articular Processes for Treatment of Lateral Crypt Stenosis and Lumbar Spinal Stenosis: Technical Report and Efficacy Analysis

Abstract

Objective To observe the clinical curative effect of posterior total endoscopic precision decompression for the treatment of single-segment lateral crypt lumbar spinal stenosis (LSS). Method A total of 27 patients with single-segment LSS satisfying the inclusion criteria were recruited from July 2013 to September 2015. There were 18 cases of unilateral stenosis of the L4-5 segments and 9 cases of unilateral stenosis of the L5-S1 segment. All patients were treated via the posterior approach with the precise lateral crypt decompression technique. Precise decompression was performed on the narrow areas causing clinical symptoms. Clinical efficacy was assessed at 3 days, 3 months, 6 months, and 2 years after surgery. Low-back pain and sciatic nerve pain assessed by visual analog scale (VAS) score and the functional Oswestry Disability Index (ODI) were used to evaluate lumbar function, and modified MacNab score criteria were used to investigate long-term efficacy. Result All patients completed the operation successfully, and the follow-up time was 2 years. The VAS score of lumbago was lower after than before surgery (preoperative: 6.96±0.90; postoperative: 2.04±1.02, P<0.05). The VAS score of sciatica was also lower after than before surgery (preoperative: 7.19±0.88, postoperative: 1.93±0.92, P<0.05), and the ODI was improved at the last follow-up (29.62±4.26) % compared with before surgery (80.07±3.98) %. The MacNab efficacy evaluation showed improvement at the end of the follow-up period: 20 cases were excellent, 6 cases were good, and 1 case was satisfactory, with a good/excellent rate of 96%. No surgical site infections, iatrogenic nerve root injuries, epidural hematomas, or other complications occurred. Conclusion Total endoscopic decompression of posterior facet arthrodesis for the treatment of single-segment lateral crypt LSS has the advantages of safety, reduced recurrence and trauma, and a satisfactory curative effect. This trial is registered with ChiCTR1800015628.

Comparison Between Percutaneous Transforaminal Endoscopic Discectomy and Fenestration in the Treatment of Degenerative Lumbar Spinal Stenosis

“…The postoperative advantages of PTED that we observed are in keeping with other reports [ 16 , 18 ]. For elderly patients, a minimally invasive technique for DLSS that results in fewer iatrogenic injuries may result in faster recovery and easer rehabilitation [ 19 ]. Shorter hospital stays may be linked with lower risks of hospital-acquired infections, particularly in elderly patients who have weak immune systems [ 20 ].…”

A Modified Laminotomy for Interlaminar Endoscopic Lumbar Discectomy: Technical Report and Preliminary Results

“…There is, however, a report used unilateral laminotomy for bilateral recess decompression [ 29 ]. Wu et al [ 30 ] reported posterior endoscopic decompression technique were good or excellent in 96% of patient who had lateral recess stenosis. Another study reported 70.8% of patients had complete pain relief and 86.5% of patients with central stenosis had subjective satisfaction after interlaminar endoscopic decompression [ 31 ].…”

“…While unilateral facetectomy of greater than 75% alter the translational displacement and flexibilities of the spinal motion segment [ 40 ], only less than a third facet joint was resected in laminotomy. Furthermore, previous studies reported that endoscopic decompression achieved significant relief of pain symptoms without affecting segmental stability [ 30 , 41 , 42 ]. In addition, cadaver study demonstrated that unilateral and bilateral facetectomies had little effect on mechanics of the spinal segment under physiologic loading [ 43 ].…”

Comparison of the short-term effects of lumbar endoscopic and microscopic tubular unilateral laminotomy with bilateral decompression in the treatment of elderly patients with lumbar spinal stenosis

“…Moreover, with a large operation space and less damage to the muscle attachment point and joint capsule of the surgical segment, the risk of postoperative low back pain is greatly reduced. The report of Wu et al showed that the Delta large channel endoscopy technology has a significant effect on the treatment of LSS [ 26 ], which can not only release the compression of the nerve by the dural sac and the bone around the nerve root, but also release the compression of soft tissues such as the intervertebral disc, posterior longitudinal ligament and ligamentum flavum, and without obvious damage to the lumbar spine [ 27 ], thereby effectively alleviating the the patient's low back and bilateral lower extremity radiological pain and improving the body function of the patient. Moreover, it can shorten the operation time and reduce the amount of intraoperative bleeding, and uses water as the operating medium, which can make the field of vision clearer [ 28 ].…”