Fully-endoscopic lumbar laminectomy for central and lateral recess stenosis: Technical note

Abstract

Abstract Background Lumbar central and lateral recess stenosis that results from a degenerative bulging of the disc and overgrowth of the facet is a very common cause for lumbar claudication and radiculopathy in the elderly. The standard surgical treatment for symptomatic lumbar central and lateral recess stenosis often requires a laminectomy. The evolution of minimally invasive techniques have created advantages for patients undergoing surgery and the authors present here a novel technique for endoscopic access to the central and lateral recess pathology that is truly minimally invasive and offers several advantages to minimally invasive spine surgeon. Methods 14 cases were performed, 10 at L4–5 and 4 at L5-S1, for the treatment of central and lateral recess stenosis. The technique was similar to that performed for minimally invasive lumbar laminectomies with a tubular retractor except, after percutaneous access to the pathological level, a cannulated 11.5 mm tubular retractor was inserted and then a 10 mm outer diameter laminoscope with a 6 mm working channel and 15° lens was inserted. Specialized endoscopic drills, forceps, and kerrison rongeurs were used to remove bony pathology and ligamentum flavum under direct visualization. Results Following surgery, the patients' symptoms showed immediate regression with continued relief at 6 month and 1 year follow up visits. Conclusions The availability of endoscopes with larger working channels (laminoscopes) and larger endoscopic instruments and drills now makes treating significant central and lateral recess lumbar stenosis with endoscopic techniques more feasible.