Abstract
PurposeThis prospective cohort study reports on a modified technique, namely precise safety decompression via double percutaneous lumbar foraminoplasty (DPLF) and percutaneous endoscopic lumbar decompression (PELD) for lateral lumbar spinal canal (LLSC) stenosis, and its short-term clinical outcomes.MethodsThe study analyzed 69 patients with single-level LLSC stenosis simultaneously occurring in both zones 1 and 2 (defined as retrodiscal space and upper bony lateral recess respectively by new LLSC classification) who underwent DPLF–PELD from November 2018 to April 2019. Clinical outcomes were evaluated according to preoperative, 3 months postoperatively, and last follow-up, via leg pain/low back pain (LBP) visual analog scale (VAS) scores, Oswestry disability index (ODI) scores, and the Macnab criteria. The postoperative MRI and CT were used to confirm the complete decompression, and flexion-extension x-rays at the last follow-up were used to observe lumbar stability.ResultsAll patients successfully underwent DPLF–PELD, and the stenosis was completely decompressed, confirmed by postoperative MRI and CT. The mean follow-up duration was 13 months (range: 8–17 months). The mean preoperative leg pain VAS score is 7.05 ± 1.04 (range 5–9), which decreased to 1.03 ± 0.79(range: 0–3) at 3 months postoperatively and to 0.75 ± 0.63 (range: 0–2) by the last follow-up visit (p < 0.05). The mean preoperative ODI was 69.8 ± 9.05 (range: 52–85), which decreased to 20.3 ± 5.52 (range: 10–35) at the third month postoperatively and to 19.6 ± 5.21 (range: 10–34) by the final follow-up visit (p < 0.05). The satisfactory (excellent or good) results were 94.2%. There was one patient with aggravated symptoms, which were relieved after an open surgery. Two patients had a dural tear, and two patients suffered postoperative LBP. No recurrence or segmental instability was observed at the final follow-up.ConclusionDPLF–PELD could be a good alternative for the treatment of LLSC stenosis patients whose stenosis occurred in both zones 1 and 2.Trial registrationChinese Clinical Trial Registry (ChiCTR1800019551). Registered 18 November 2018.
Highlights
Along with the aging of society, the incidence of degenerative lumbar disorders has increased, becoming one of the main reasons for lumbar surgery in elderly patients [1, 2]
We found that the retrodiscal space and upper bony lateral recess were the two most common regions for occurrence of lumbar degeneration
Two patients complained of moderate postoperative low back pain (LBP) without lumbar muscle weakness, which disappeared after conservative treatment
Summary
Along with the aging of society, the incidence of degenerative lumbar disorders has increased, becoming one of the main reasons for lumbar surgery in elderly patients [1, 2]. Owing to the remarkable evolution of percutaneous endoscopic lumbar decompression (PELD), the application of spinal endoscopy is shifting from the treatment of soft disk herniation to complex lumbar spinal stenosis. Satisfactory results of PELD in treating lumbar spinal stenosis (LSS) are reported at 82–92% [3]. After carefully analyzing the spinal anatomy and clinical facts, Yu Wang et al recently redefined the concept “lateral lumbar spinal canal” (LLSC) and creatively provided a new classification of LLSC with five different zones [8]. We found that the retrodiscal space (zone 1) and upper bony lateral recess (zone 2) were the two most common regions for occurrence of lumbar degeneration. Stenosis simultaneously occurring in both zones 1 and 2 were most common (43.4%) [8]. Endoscopic decompression for patients was difficult, even for experienced endoscopic spine surgeons, due to the complicated compressive situation
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