Step-by-Step Sublaminar Approach With a Newly-Designed Spinal Endoscope for Unilateral-Approach Bilateral Decompression in Spinal Stenosis

Abstract

Objective Spinal stenosis is increasingly common due to population aging. In elderly patients with lumbar central canal stenosis (LCCS), minimizing muscle damage and bone resection is particularly important. We performed a step-by-step operation with a newly designed spinal endoscope to obtain adequate decompression in patients with spinal stenosis. Methods From April 2015 to August 2016, 78 patients (48 males, 30 females) with LCCS (91 segments) underwent endoscopic decompression using a newly designed endoscope system. The inclusion criteria were: (1) neurogenic intermittent claudication with or without radiculopathy, (2) LCCS, and (3) having exhausted conservative treatment (>3 months). The exclusion criteria were: (1) >10° of instability, (2) spondylolisthesis grade II or greater according to the Meyerding criteria, (3) foraminal stenosis, (4) vascular intermittent claudication, (5) infection, and (6) stenosis combined with malignancy. We performed a step-by-step procedure using a newly designed endoscope system for unilateral-approach bilateral decompression. We used the same incision for 2–3 segments, only moving the skin. Results The mean follow-up was 2.3±1.3 years. Excellent or good results were found according to the MacNab criteria in 85.9% of cases (67 of 78). The visual analogue scale, Japanese Orthopedic Association score, and Oswestry Disability Index showed significant decreases at 1 month, persisting until the 2-year follow-up. Dural tear occurred in 4 cases (5.1%), and patch repair was performed under endoscopy. No patients experienced aggravated instability requiring surgery. Conclusion We obtained good results with endoscopic decompression surgery using a newly designed instrument that minimized muscle and bone damage in elderly patients with spinal stenosis.

Development of Endoscopic Spine Surgery for Healthy Life: To Provide Spine Care for Better, for Worse, for Richer, for Poorer, in Sickness and in Health

“…However, these complications can be potentially avoided with various endoscopic spinal procedures that can be done under local anaesthesia and epidural anaesthesia, which allow for early postoperative recovery and mobility without a significant effect on the central nervous system. [32][33][34][35][36]…”

Lumbar Endoscopic Unilateral Laminotomy for Bilateral Decompression Outside-In Approach: A Proctorship Guideline With 12 Steps of Effectiveness and Safety

“…[8][9][10] The outside-in technique of decompression is what is described as over the top decompression in minimally invasive literature for both microscopic and endoscopic surgery. [11][12][13] The authors defined outsidein technique of endoscopic stenotic decompression as bony decompression of cephalad lamina, caudal lamina, inferior articular process, and superior articular process ("outside") to the extent that is sufficient for complete release of ligamentum flavum prior to removal of ligamentum en bloc with blunt instrument in the last part of the procedure to expose the spinal canal ("in"). The inside-out technique, on the other hand, involved bony decompression of lamina, inferior articular process, and superior articular process with early splitting of ligamentum flavum to get into spinal canal ("inside") prior to releasing ligamentum flavum from within the spinal canal with concurrent bony decompression ("out").…”

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

“…Ito et al demonstrated improved VAS, ODI and Japanese Orthopedic Association (JOA) score after conducting endoscopic decompression with sublaminar approach. [24] Kang et al compared biportal endoscopic surgery with microscopic surgery and found that there was shorter hospital stay, shorter operation time, less hemovac drainage and less opioid use in endoscopic surgery group. [25] Kim and Choi found satisfactory results at minimum 2-year follow-up with no wound infection or segmental spinal instability after conducting endoscopic decompression for lumbar spinal stenosis.…”