Endoscopic spinal surgery using a new tubular retractor with 15 mm outer diameter

Abstract

Purpose: To assess whether the instrument handling and image quality of endoscopic spinal decompression procedures is adequate and effects the treatment of degenerative spinal disorders.Material and Methods: Forty-six patients underwent endoscopic procedures for radicular pain or sensorimotor deficit due to a degenerative disorder using a 15mm tubular retractor. Endoscopic video recordings were reviewed with focus on instrument handling and intraoperative complication. At final follow-up the clinical outcome was assessed via a standardized questionnaire including the Oswestry Disability Index (ODI) Neck Disability Index (NDI), Odoms criteria and a personal examination focusing on pain, and sensorimotor deficits.Results: Forty out of 46 patients attended a final follow-up (86.9%). The mean follow-up time was 51.8 month (range 15–84 month). At final follow-up, of patients who were operate at the lumbar spine 93.9% and at the cervical spine 85.7% were free of radicular pain, no weakness was documented in 84.9% of cases after lumbar and 85.7% after cervical spine procedure, and according to Odoms criteria clinical success was noted in 84.5% and 100%, respectively. The mean ODI was 9.0% and mean NDI was 11.7%. The dural tear rate was 4.3%, all dural tear were closed endoscopically. The recurrent disc herniation rate was 6.1%.Conclusions: Endoscopic decompression using a 15m tubular retractor offers a good view onto the surgical field and a high clinical success rate. The decompression of degenerative pathologies in bimanual technique is not limited by a 15mm tubular retractor.