Percutaneous transforaminal full endoscopic decompression for the treatment of lumbar spinal stenosis

Peigen Xie,Feng Feng,Wenbin Wu,Zihao Chen,Chien-Min Chen,Tao Shu,Limin Rong,Ruiqiang Chen,Jianwen Dong,Bin Liu,Lei He,Bu Yang,Liangming Zhang

doi:10.1186/s12891-020-03566-x

Abstract

BackgroundOne advantage of an endoscopic approach to treating lumbar spinal stenosis is preservation of spine stability and the adjacent anatomy, and there is a decrease in adjacent segment disc degeneration. The purpose of this study was to discuss the clinical efficacy of percutaneous transforaminal endoscopic decompression for the treatment of lumbar spinal stenosis (LSS).MethodsThis is a retrospective study. From September 2012 to June 2017, 45 patients who were diagnosed with LSS underwent the treatment of percutaneous transforaminal endoscopic decompression (PTED) and were followed up at 1 week, 3 months and 1 year postoperatively. Low back pain and leg pain were measured by Visual Analogue Scale scoring methods (VAS-back and VAS-leg), while functional outcomes were assessed by using the Oswestry Disability Index (ODI). All patients had one-level lumbar spinal stenosis.ResultsThe most common type of stenosis was lateral recess stenosis (n = 22; 48.9%), followed by central stenosis (n = 13; 28.9%) and foraminal stenosis (n = 10: 22.2%). Regarding comparisons of VAS-back, VAS-leg, and ODI scores before and after operation, VAS and ODI scores significantly improved. The average leg VAS score improved from 7.01 ± 0.84 to 2.28 ± 1.43 (P < 0.001). The average ODI improved from 46.18 ± 10.11 to 14.40 ± 9.59 (P < 0.001). We also examined changes in ODI and VAS scores from baseline according to types of spinal stenosis, stenosis grade, spinal instability, and revision surgery in the same segment. The improvement percentage of leg VAS score was significantly less in patients with severe stenosis at both 3 months and 1 year postoperatively. The improvement percentages of ODI and leg VAS scores were significantly less in patients who had spinal instability and patients who had undergone revision surgery.ConclusionThe PTED approach seems to give good results for the treatment of LSS. However, this approach may be less effective for LSS patients who have lumbar instability or require revision surgery in the same segment.

Highlights

Lumbar spinal stenosis (LSS) is a lumbar vertebrae disease resulting from degenerative changes caused by the narrowing of the central canal, the lateral recess, or neural foramen [1]
The results of this study demonstrate that percutaneous transforaminal endoscopic decompression can be an effective treatment for elderly patients with lumbar spondylosis and spinal stenosis
In a case series study, 85 patients having lumbar lateral recess stenosis with or without combined herniated discs were treated with percutaneous lumbar foraminoplasty and percutaneous endoscopic lumbar discectomy (PLF-PELD) and 90.6% of them reported the outcome as satisfactory [20]

Summary

Introduction

Lumbar spinal stenosis (LSS) is a lumbar vertebrae disease resulting from degenerative changes caused by the narrowing of the central canal, the lateral recess, or neural foramen [1]. LSS is more commonly diagnosed in an aging population. Both surgical and conservative approaches have been used for the management of LSS. It has been suggested that percutaneous endoscopic discectomy may be an efficient alternative to conventional open lumbar decompression surgery when treating lumbar spinal stenosis [2]. The argument for this is that open decompressions for spinal stenosis have a high complication rate and are painful to recover from but endoscopic techniques for decompressing herniated discs have shown low complication and morbidity rates. The purpose of this study was to discuss the clinical efficacy of percutaneous transforaminal endoscopic decompression for the treatment of lumbar spinal stenosis (LSS)

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Results

Conclusion