Abstract

Introduction: Endoscopic surgery is one of the methods that achieve the goal of decompression while minimizing collateral tissue damage. Its efficacy and safety have been supported by numerous studies. There is a plethora of studies on lumbar stenosis regarding the outcomes and related issues in endoscopic spine surgery. However, few studies evaluated the outcome of the decompressive lumbar spine surgery. The present study aims to analyze the outcome of a unilateral approach to endoscopic surgery for lumbar stenosis using the visual analog scale (VAS), the Oswestry Disability Index (ODI), and MacNab's criteria.Methods: This is a retrospective study (level IV) conducted between January 2009 and December 2013 on 60 patients who underwent endoscopic interlaminar decompressive spine surgery (Destandau method) for lumbar degenerative spinal stenosis in the Hospital Universiti Sains Malaysia. The clinical outcome was measured pre-operatively and post-operatively for VAS: for back and leg pain, motor and sensory grading, the ODI, and MacNab's criteria. A paired t-test was used for statistical analysis.Results: The mean age of patients was 60.82 years comprising 23 males (38.3%) and 37 females (61.7%). The mean follow-up period was 30.1 months (range = 17.2–43 months). The mean operation time was 183.6 min (ranging from 124.8 to 242.4 min), and the mean blood loss was 150.18 mL (ranging from 30.82 to 269.54 mL). Post-operatively, mean hospital stay was 2.45 days (ranging from 1.34 to 3.56 days). The most frequently involved level was L4/L5 in 51 patients (52.6%), followed by L3/L4 in 19 patients (19.6%), L5/S1 in 24 patients (24.7%), and L2/L3 in three patients (3.1%). Improvement in the post-operative VAS for back and leg pain and the ODI for pre-operation and post-operation was statistically significant (p < 0.001). Conversely, the reduction in neurological status was statistically insignificant. Based on MacNab's criteria, 88.4% showed excellent to good outcomes.Conclusion: To summarize, unilateral percutaneous endoscopic spine surgery to achieve the bilateral decompression in lumbar stenosis provides excellent yet safe and effective outcomes. It improves back and leg pain and patients' function significantly.

Highlights

  • Endoscopic surgery is one of the methods that achieve the goal of decompression while minimizing collateral tissue damage

  • Lumbar spinal stenosis (LSS) is a disease pathology that emerges from various sites such as the intervertebral disc, capsule, bone, and ligament

  • The present study aims to determine the clinical outcomes of endoscopic surgery by using the unilateral hemilaminotomy and bilateral decompression approach for LSS

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Summary

Introduction

Endoscopic surgery is one of the methods that achieve the goal of decompression while minimizing collateral tissue damage. There is a plethora of studies on lumbar stenosis regarding the outcomes and related issues in endoscopic spine surgery. Few studies evaluated the outcome of the decompressive lumbar spine surgery. The present study aims to analyze the outcome of a unilateral approach to endoscopic surgery for lumbar stenosis using the visual analog scale (VAS), the Oswestry Disability Index (ODI), and MacNab’s criteria. Despite the conventional open decompression, Kambin and Gellman [4] had used the posterior transcanal endoscopic by using Craig cannula in 1973. A few years later, in 1975, Hijikata et al [5] introduced a standalone procedure of a non-visualized posterolateral percutaneous nucleotomy followed by Kambin and Gellman [4], who reported nine cases of similar procedure in 1983. In 1998, Kambin et al [8] used the transforaminal biportal approach to excise central herniation and non-migrated sequestrated disk fragments in 59 cases

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