Single Incision Tubular Decompression to Treat Multi-level Lumbar Spinal Stenosis: A Retrospective Review

Abstract

Objective: To evaluate the technical feasibility and assess the clinical outcomes of tubular decompression (TD) in cases of multilevel lumbar canal stenosis operated through a single incision. TD has established itself in the surgical management of single level lumbar stenosis. Literature on performance of TD for multilevel stenosis through a single incision are non-existent.Methods: All patients undergoing TD for multilevel lumbar stenosis through a single incision from January 2007 to January 2018 were included. Patient demographics, operative and peri-operative details were documented. Patient based clinical outcomes, namely Visual Analogue Scale (VAS) scale for back and leg pain and Oswestry Disability Index (ODI) were assessed. Results: Favorable tube trajectory and adequate decompression could be achieved through a single incision to decompress multiple levels. The VAS improved from mean 31.5 (2–5) to 20.8 (1–4) and 71.4 (4–9) to 21 (1–5) for back and leg pain respectively; while the ODI improved from a mean 44.68.6 (32–68) to 20.25.3 (16–42) at 3 months post-op and was maintained at 10.8 (1–4), 1.60.67 (1–3) and 192.9 (16–26) respectively at 2 years follow-up.Conclusion: TD for multilevel stenosis done through a single incision is a feasible option with good to excellent results.

Microsurgical and Descriptive Three-Dimensional Analysis of the Subarticular Trigone: A Guidemap for Standardizing Lateral Recess Decompression

“…In recent decades, compression of the traversing nerve root within the subarticular gutter has emerged as one of the most prevalent degenerative pathologies treated by spinal surgeons. Addressing such compressions involves a range of treatment modalities, spanning from nerve root injections and open lateral recess decompressions through unilateral selective approaches to minimally invasive techniques and more recently endoscopic approaches [ 4 , 5 , 7 , 8 , 19 , 20 ]. Alongside a gross anatomical delineation of the lateral recess, a microsurgical comprehension of the involved region is imperative to ensure thorough decompression without extensive facet/pars damage that would lead to instability, as well as procedural reproducibility, thereby mitigating the learning curve associated with these techniques.…”

Outcomes of Microscopic-Assisted Decompression Surgery Without Instrumented Fixation in Patients With Spinal Canal Stenosis and First-Degree Degenerative Spondylolisthesis: A Prospective Case Series

“…While several innovations and techniques exist to perform less invasive decompressions, including subarticular fenestration and multiple laminotomies [19][20][21], microscopic decompression [25,31] and tubular decompression [32][33][34][35], the aim of this study is to report our outcomes of microscopic-assisted decompression in first-degree symptomatic DS cases through over-the-top technique, particularly regarding clinical improvement and radiological progression of instability. Despite the presence of similar published reports regarding the same tech-nique [24][25][26], the existing prospective studies were few and the results were nonconsistent specially regarding slip progression.…”