Abstract
Purpose The purpose of our study is to compare the results of spinal decompression using the full-endoscopic interlaminar technique, tubular retractor, and a conventional microsurgical laminotomy technique and evaluate the advantages and clinical feasibility of minimally invasive spinal (MIS) lumbar decompression technique in the lumbar canal and lateral recess stenosis. Methods The authors retrospectively reviewed clinical and radiological data from 270 patients who received microsurgical (group E: 72 patients), tubular (group T: 34 patients), or full-endoscopic decompression surgery (group E: 164 patients) for their lumbar canal and lateral recess stenosis from June 2016 to August 2017. Clinical (VAS, ODI, and Mcnab criteria), radiologic (spinal canal diameter, segmental dynamic angle, and disc height), and surgical outcome parameters (CPK level, Operative time, blood loss, and hospital stay) were evaluated pre- and postoperatively and compared among the three groups by means of statistical analysis. Failed cases and complications were reviewed in all groups. ResultsThe mean follow-up period was 6.38 months. The Overall clinical success rate was 89.4%. All groups showed favorable clinical outcome. The clinical and radiologic results were similar in all groups. Regarding surgical outcome, group E showed longer operation time than group M and T (group E: 84.17 minutes/level, group M: 52.22 minutes/level, and group T: 66.12 minutes/level) (p<0.05). However, groups E and T showed minimal surgical invasiveness compared with group M. Groups E and T showed less immediate postoperative back pain (VAS) (group E: 3.13, group M: 4.28, group T: 3.54) (p<0.05), less increase of serum CPK enzyme (group E: 66.38 IU/L, group M: 120 IU/L, and group T: 137.5 IU/L) (p<0.05), and shorter hospital stay (group E: 2.12 days, group M: 4.85 days, and group T: 2.83 days) (p<0.05). The rates of complications and revisions were not significantly different among the three groups. ConclusionsMIS decompression technique is clinically feasible and safe to treat the lumbar canal and lateral recess stenosis, and it has many surgical advantages such as less muscle trauma, minimal postoperative back pain, and fast recovery of the patient compared to traditional open microscopic technique.
Highlights
Traditional treatment of spinal stenosis has been wide laminectomy involving undercutting of the medial facet and foraminotomy [1]
A retrospective review was performed on 270 patients (187f, 83m) who had undergone full-endoscopic (164 patients), tubular (34 patients), and microscopic (72 patients) laminotomy and flavectomy, for degenerative lumbar central or lateral recess stenosis between June 2016 and August 2017 at a single center
Inclusion criteria were patients who were preoperatively diagnosed with lumbar central canal or lateral recess stenosis with the symptoms of neurogenic intermittent claudication (NIC) and radiculopathy and refractory to conservative treatment at least for three months
Summary
Traditional treatment of spinal stenosis has been wide laminectomy involving undercutting of the medial facet and foraminotomy [1]. Among those MIS decompression techniques for the lumbar canal and lateral recess stenosis, techniques by using tubular retractor and percutaneous endoscope have been reported to have many surgical advantages such as less postoperative back pain and benefits for rehabilitation [3, 5,6,7,8,9,10,11,12]. The present study was undertaken to retrospectively compare the results of spinal decompression using the full-endoscopic interlaminar technique (group E), tubular retractor (group T), and a conventional microsurgical laminotomy technique (group M) with a goal to evaluate the advantages and clinical
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