Surgical treatment for lumbar lateral recess stenosis with the full-endoscopic interlaminar approach versus conventional microsurgical technique: a prospective, randomized, controlled study

Ruetten, Sebastian; Komp, Martin; Merk, H.; Godolias, Georgios

doi:10.3171/2008.7.17634

Cited by 255 publications

(206 citation statements)

References 116 publications

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“…Third, due to a lack of a control group we cannot make any assessment regarding how this technique compares to other surgical techniques. However, given that we used the interlaminar technique pioneered by Dr. Ruetten and colleagues, we expect our long-term results to be comparable (47).…”

Section: Discussionmentioning

confidence: 91%

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Interlaminar endoscopic lateral recess decompression—surgical technique and early clinical results

Birjandian¹,

Emerson²,

Telfeian³

et al. 2017

J. Spine Surg.

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Background: Lateral recess stenosis is a common pathology causing de-novo or residual radicular pain following lumbar spine surgery. Diagnostic criteria and treatment strategies for symptomatic lateral recess stenosis are not well established. Methods:We identified ten patients in our prospective patient database (n=146) who underwent endoscopic interlaminar decompression for unilateral symptomatic lateral recess stenosis. Lateral recess height and angle were measured on axial T2-weighted MRI. Values from the symptomatic side were compared to the contralateral side which served as asymptomatic control. Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) for back and leg pain were collected preoperatively, postoperatively and at last follow-up.Results: Preoperative MRI revealed that both lateral recess angle and height were significantly smaller on the symptomatic compared to the asymptomatic side (angle: 19.3˚ vs. 35.7˚; height: 2.9 vs. 5.7 mm; P<0.01).All patients tolerated endoscopic interlaminar decompression well and half of the patients were discharged on the day of surgery. At last follow-up (12.6±1.7 months), 8 out of 10 patients experienced a minimally clinically important improvement of their VAS for ipsilateral leg pain, which improved from 7.2±0.5 preoperatively to 2.5±0.8 postoperatively (P=0.001). The back pain VAS also improved (preoperatively 5.1±1.1 vs. postoperatively 1.7±0.9, P<0.05). The ODI improved from 50±5.8 preoperatively to 22.2±5.1 at last follow-up (P=0.001). One patient experienced persistent leg pain.Conclusions: Lateral recess height and angle correlate with symptomatic lateral recess stenosis which is effectively treated utilizing interlaminar endoscopic lateral recess decompression.

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Section: Discussionmentioning

confidence: 91%

“…At a mean follow-up time of 10.5 months VAS for radiculopathy improved from 6.5 to 1.1. The results of fully endoscopic spine surgery have been published for lateral recess stenosis (47). The authors included a total of 161 patients who were randomized either into microsurgical or endoscopic lateral recess decompression.…”

Section: Discussionmentioning

confidence: 99%

Interlaminar endoscopic lateral recess decompression—surgical technique and early clinical results

Birjandian¹,

Emerson²,

Telfeian³

et al. 2017

J. Spine Surg.

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“…Moreover, the duration of hospital stay was significantly shorter in the unilateral laminotomy group. We excluded eight studies because the control group did not meet the criteria of this review [6,[41][42][43][44][45][46][47]. We excluded three studies because the design precluded a reliable comparison of decompression techniques [48][49][50].…”

Section: Excluded Studiesmentioning

confidence: 99%

Effectiveness of posterior decompression techniques compared with conventional laminectomy for lumbar stenosis

et al. 2015

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Purpose To compare the effectiveness of techniques of posterior decompression that limit the extent of bony decompression or to avoid removal of posterior midline structures of the lumbar spine versus conventional facetpreserving laminectomy for the treatment of patients with degenerative lumbar stenosis. Methods A comprehensive electronic search of the Cochrane Central Register of Controlled Trials, MED-LINE, EMBASE, Web of Science, and the clinical trials registries ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform was conducted for relevant literature up to June 2014. Results A total of four high-quality RCTs and six lowquality RCTs met the search criteria of this review. These studies included a total of 733 participants. Three different techniques that avoid removal of posterior midline structures are compared to conventional laminectomy; unilateral laminotomy for bilateral decompression, bilateral laminotomy and split-spinous process laminotomy. Evidence of low or very low quality suggests that different techniques of posterior decompression and conventional laminectomy have similar effects on functional disability and leg pain. Only perceived recovery at final follow-up was better in patients that underwent bilateral laminotomy compared with conventional laminectomy. Unilateral laminotomy for bilateral decompression and bilateral laminotomy resulted in numerically fewer cases of iatrogenic instability, although in both cases, the incidence of instability was low. The difference in severity of postoperative low back pain following bilateral laminotomy and split-spinous process laminotomy was significantly less, but was too small to be clinically important. We found no evidence to show that the incidence of complications, length of the procedure, length of hospital stay and postoperative walking distance differed between techniques of posterior decompression. Conclusion The evidence provided by this systematic review for the effects of unilateral laminotomy for bilateral decompression, bilateral laminotomy and split-spinous process laminotomy compared with conventional laminectomy on functional disability, perceived recovery and leg pain is of low or very low quality. Therefore, further research is necessary to establish whether these techniques provide a safe and effective alternative for conventional laminectomy. Proposed advantages of these techniques regarding the incidence of iatrogenic instability and postoperative back pain are plausible, but definitive conclusions are limited by poor methodology and poor reporting of outcome measures among included studies.

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“…The size of the surgical approach corridor was reduced even further with the introduction of microendoscopic approaches through a 16 mm tubular retractor (14). Ruetten et al presented their results for posterior fully endoscopic treatment of lateral recess stenosis and found the success to be comparable to a microsurgical control group (15). The approach presented here is a technical nuance to the endoscopic lateral recess decompression procedure.…”

Section: Discussionmentioning

confidence: 99%

Contralateral facet-sparing sublaminar endoscopic foraminotomy for the treatment of lumbar lateral recess stenosis: technical note

Krzok¹,

Telfeian

Wagner

et al. 2017

J. Spine Surg.

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Lumbar lateral recess stenosis that results from a degenerative bulging of the disc and overgrowth of the facet is a very common cause for lumbar radiculopathy in the elderly. The standard surgical treatment for symptomatic lumbar lateral recess stenosis often requires a laminectomy or hemi-laminectomy and medial facetectomy which can further destabilize a pathological motion segment. The authors present here a novel technique for contralateral endoscopic access to the lateral recess pathology that is truly minimally invasive and spares most of the facet joint complex: 6 patient cases are described where lateral recess stenosis pathology was accessed from a contralateral sublaminar endoscopic approach.

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Surgical treatment for lumbar lateral recess stenosis with the full-endoscopic interlaminar approach versus conventional microsurgical technique: a prospective, randomized, controlled study

Cited by 255 publications

References 116 publications

Interlaminar endoscopic lateral recess decompression—surgical technique and early clinical results

Interlaminar endoscopic lateral recess decompression—surgical technique and early clinical results

Effectiveness of posterior decompression techniques compared with conventional laminectomy for lumbar stenosis

Contralateral facet-sparing sublaminar endoscopic foraminotomy for the treatment of lumbar lateral recess stenosis: technical note

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