Percutaneous transforaminal endoscopic bilateral decompression via unilateral approach for lumbar spinal stenosis caused by lumbar disc herniation

Abstract

Objective To evaluate the clinical results of percutaneous transforaminal endoscopic bilateral decompression (PTED)via unilateral approach for lumbar spinal stenosis (LSSS) caused by lumbar disc herniation (LDH). Methods From January 2014 to January 2016, 35 cases of LSS caused by LDH were treated with PTED via unilateral approach at Affiliated Hospital of Logistics University of Chinese Armed Police Force, and their data were used for a retrospective analysis. The surgical effect was evaluated using the Macnab score at 3 months post-operation. Visual analogue scale (VAS) and Oswestry disability index(ODI)were used to assess the outcomes at 6 month post-operation.MxLiteView DICOM Viewer software was used to measure the change of spinal canal area before and after operation based on the parameters of axial MRI images. Results The mean operation time was (89.1±8.7) min in 35 patients.The preoperative and 6-month postoperative VAS values were (7.9±0.8) and (2.1±0.5) points, respectively, and the ODI were(61.5±3.7) and(21.3±2.1)points, respectively. Both differences were statistically significant (P<0.05). As per the Macnab criteria, 19 patients (54.4%) reported excellent effect, 13 (37.1%) demonstrated good outcome, 2 (5.7%) reported faireffect, and 1 (2.9%) demonstrated poor result.The excellent/good rate reached 91.4%. Compared with the preoperative conditions, the cross sectional areas of spinal canal at the levels of L3-4, L4-5 and L5-S1were increasedby (35.7±8.5) mm2, (40.9±4.1) mm2 and (42.5±9.1) mm2, respectively.No postoperative rupture of spinal dura, or injury of nerves, blood vesselsas well as intestines, or infection occurred in this series. The most frequently observed complication was transient paresthesia due to irritation of nerve root. Conclusions The procesure of PTED via unilateral approach demonstrate satisfactory short-term effect in the treatment of LSS caused by LDH. Further long-term observations are needed to investigate postoperative stability of lumbar spinal canal, the risk of restenosis, and possibility of re-operation in case of restenosis. Key words: Spinal stenosis; Lumbar vertebrae; Decompression, surgical; Percutaneous transforaminal endoscopic discectomy; Bilateral decompression via unilateral approach