Preliminary results of a novel pure endoscopic procedure in the treatment of degenerative lumbar spinal disorders: double endoscopic technique.

Abstract

With increased experience and the availability of new technical instrumentations, the surgical endoscopic indications for lumbar spinal pathologies have moved from simple prolapsed disk to canal stenosis. The available endoscopes come in two different sizes (10 mm and 6.3 mm in diameter); however, one is too bulky to use inside the spinal canal and the other is too small to achieve a fast bone decompression. In order to overcome such problems, we developed and used a different surgical technique called: double endoscopic technique. Using this approach, we operated and prospectively collected clinical information on 17 patients (Group A) suffering from a mixed (ligament-bone hypertrophy and prolapsed disk) single segmental lumbar canal stenosis. At a median of 13 months from surgery, all the patients in this group had a very good outcome with an improvement of the VAS and ODI. These clinical results were compared with those from another group of patients who had undergone surgery in the same unit but using standard MIS technique (Group B). Both groups were similar in terms of number, age, symptoms and stenosis location. We compared the pre- and postoperative VAS and ODI values, the amount of postoperative pain killers used during the first week postsurgery, the length of in-hospital stays as well as the blood loss during surgery. Although our aim was only to present a novel surgical endoscopic technique, the results, with all the study limitations including small numbers and short follow-up, have shown that this procedure is safe and effective, yielding an outcome comparable to the standard MIS approach. Furthermore, it is less disruptive towards the involved anatomy, it gives less postoperative pain, it requires a smaller skin incision, and the blood loss is negligible. Thus, this technique may guarantee a faster clinical recovery.