Endoscopic Foraminoplasty and Neuro-Ventral Decompression for the Treatment of Lumbar Disc Herniation Combining with Lateral Recess Stenosis

Zhang Jian Jun,Cui Hong Peng,Lu Zheng Cao,Zhu Kai,Ding Yu,Fu Ben Sheng

doi:10.4172/2165-7939.1000412

Abstract

Objective: To evaluate the feasibility and clinical effect of endoscopic foraminoplasty and neuro-ventral decompression for the treatment of lumbar disc herniation combining with lateral recess stenosis. Method: From June 2015 to August 2016, thirty patients with typical radicular symptoms and neurogenic intermittent claudication were treated. There were 17 cases with lumbar disc herniation with lateral recess stenosis at L4/L5 and 13 cases at L5/S1. The mean course of disease was 10.6 ± 6.1 months. The preoperative and postoperative visual analogue scales (VAS) were used to assess the intensity of pain. The outcomes were evaluated by Oswestry disability index (ODI) and Japanese Orthopaedic Association Scores (JOA). Clinical signs were observed and compared before and after the operation. These patients had undergone the normalized endoscopic foraminoplasty for spinal canal decompression and discectomy to decompress the traversing and exiting nerve. Result: Based on MacNab's criteria assessment, 17 patients (56.7%) showed excellent, 9 (30.0%) good, 4 (10%) fair, and 0 (0%) poor results. Our results demonstrated that normalized endoscopic foraminoplasty for the treatment of lumbar disc herniation combined with lateral recess stenosis can significantly improve the VAS, ODI and JOA score at each time point postoperatively compared with preoperative parameters (P<0.05). There were no significant differences in the VAS, ODI and JOA scores at each postoperative time point compared with immediate postoperative assessment. Conclusion: The endoscopic foraminoplasty and neuro-ventral decompression is safe, and efficacious for the treatment of lumbar disc herniation with concomitant lateral recess stenosis. Careful selection of surgical indication, and normalized, skilled surgical techniques are the key to the successful clinical outcome

Highlights

Lumbar disc herniation and lateral recess stenosis is one of the common sequel of spinal degenerative disease
Our clinical center has adopted the treatment of normalized endoscopic foraminoplasty and neuro-ventral decompression (FNVD) for thirty cases of the lumbar disc herniation combining with lateral recess stenosis
It is well known that common factors for spinal stenosis, such as intervertebral disc herniation, osteophyte at vertebral posterior margin and internal hyperplasia of the articular process, could be resolved with ventral decompression by ventral decompression through transforaminal approach, in which could protect ligamentum flavum, the important physiologic structure

Summary

Introduction

Lumbar disc herniation and lateral recess stenosis is one of the common sequel of spinal degenerative disease. Compared with the traditional posterior lumbar open surgery, the percutanous transforaminal surgery is with less trauma, less impact to the normal anatomical structure, faster and rapid recovery. The wide application of percutaneous transforaminal endoscopy makes it possible for surgeons to reach the ventral part of nerve root and dural sac. With the maturity of PTED, many surgeons have explored the application of transforaminal endoscopic technique in lumbar spinal stenosis. Our clinical center has adopted the treatment of normalized endoscopic foraminoplasty and neuro-ventral decompression (FNVD) for thirty cases of the lumbar disc herniation combining with lateral recess stenosis. We removed the prolapsed tissue under the direct vision for cauda equina and nerve root decompression and reduced the destabilizing impact on the spinal structure as much as possible, which achieved better clinical efficacy

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