Microendoscopic Decompression Research Articles

Efficacy and safety of multidrug cocktail injections in postoperative pain management for lumbar microendoscopic decompression surgery: a prospective randomized controlled trial.

This study aimed to evaluate the analgesic effects and safety of multidrug cocktail injections for postoperative pain management in patients undergoing lumbar microendoscopic decompression surgery. A prospective randomized controlled trial was conducted with 70 patients who underwent lumbar microendoscopic decompression surgery between December 2023 and May 2024. Patients were randomly assigned to receive either a multidrug cocktail injection (cocktail group, n = 35) or no cocktail injection (non-cocktail group, n = 35). Primary outcomes included scores of the numerical rating scale (NRS) for pain from postoperative days 1 to 7 and the number of analgesics used within the first 3 postoperative days. Secondary outcomes included sex, age, body mass index, preoperative diagnosis, surgical levels, duration of surgery, blood loss, C-reactive protein (CRP) levels on postoperative day 1, and drain output. The cocktail group experienced significantly lower pain levels from postoperative days 1 to 7 (p < 0.05) and used fewer analgesics within the first 3days (p = 0.01) compared with the non-cocktail group. Additionally, the cocktail group had significantly lower CRP levels (p < 0.001) and a shorter hospital stay (p = 0.01). No significant differences were observed in the duration of surgery, blood loss, or drain output between the groups. Multidrug cocktail injections are effective and safe for postoperative pain management in lumbar microendoscopic decompression surgery, significantly reducing pain, analgesic use, CRP levels, and hospital stay. These findings suggest that incorporating multidrug cocktail injections into postoperative care protocols can enhance patient recovery and outcomes.

Microendoscopic Tailored Spine Decompression as a Less-Invasive, Stability-Preserving Surgical Option to Instrumented Correction in Complex Spine Deformities: A Preliminary Multicenter Experience

Study designA series of 32 patients, submitted to a tailored stability-preserving micro-endoscopic decompression for lumbar spine degenerative disease was retrospectively analyzed. ObjectivesThe aim of this study is to explore the effectiveness of a less invasive posterior spine decompression in complex deformities. We studied the potential advantages of the micro-endoscopic approach, supplemented by the piezoelectric technique, to decompress both sides of the vertebral canal, from a one side approach to preserve spine stability, ensuring an adequate neural decompression. MethodsThe patients were submitted to a selective bilateral decompression, using a monolateral approach, without the skeletonization of the opposite side. For the omo- and the contralateral decompression, we used a microscopic endoscopy-assisted approach, with the assistance of Piezosurgery, for a safe work near the exposed dura mater. Piezoelectric osteotomy is extremely effective in bone removal while safe on soft tissues. ResultsIn all patients an adequate decompression was achieved with a high rate of spine stability preservation. The approach was essential in minimizing the opening, so reducing the risk of spine instability. Piezoelectric osteotomy was useful to safely perform the undercutting of the base of the spinous process, for a better contralateral vision and decompression without damaging the exposed dura. In all patients a various degree of neurological improvement was observed, with no immediate spine decompensation. ConclusionsIn selected cases, the tailored micro-endoscopic monolateral approach for bilateral spine decompression, with piezosurgery assistance, is adequate and safe and showed excellent results in terms of spine decompression and stability preservation.

Rate of Reoperation Following Decompression-Only Procedure for Lumbar Degenerative Spondylolisthesis: A Systematic Review of Literature.

Management of lumbar degenerative spondylolisthesis with decompression-only procedure has been performed for its added benefit of a shorter duration of surgery, lower blood loss, and shorter hospital stay. However, reported failure rates for decompression-only procedures vary depending on the methods utilized for decompression. Hence, we aim to identify the failure rates of individual methods of decompression-only procedures performed for degenerative lumbar spondylolisthesis. An independent systematic review of 4 scientific databases (PubMed, Scopus, clinicaltrials.gov, Web of Science) was performed to identify relevant articles as per the preferred reporting in systematic reviews and meta-analysis guidelines. Studies reporting on failure rates defined by reoperation at the index level following decompression-only procedure for degenerative lumbar spondylolisthesis were included for analysis. Studies were appraised using ROBINS tool of Cochrane, and analysis was performed using the Open Meta[Analyst] software. The overall failure rate of decompression-only procedure was 9.1% (95% confidence interval [CI] [6.5-11.7]). Furthermore, open decompression had failure rate of 10.9% (95% CI [6.0-15.8]), while microendoscopic decompression had failure rate of 6.7% (95% CI [2.9-10.6]). The failure rate gradually increased from 6.9% (95% CI [2.0-11.7]) at 1 year to 7% (95% CI [3.6-10.3]), 11.7% (95% CI [4.5-18.9]), and 11.7% (95% CI [6.6-16.7]) at 2, 3, and 5 years, respectively. Single level decompression had a failure rate of 9.6% (95% CI [6.3-12.9]), while multilevel decompression recorded a failure rate of 8.7% (95% CI [5.6-11.7]). High-quality evidence on the decompression-only procedure for degenerative spondylolisthesis is limited. The decompression-only procedure had an overall failure rate of 9.1% without significant differences between the decompression techniques. Level IV. See Instructions for Authors for a complete description of levels of evidence.

Open laminectomy vs. minimally invasive laminectomy for lumbar spinal stenosis: a review.

Lumbar spinal stenosis (LSS) refers to a narrowing of the space within the spinal canal, which can occur at any level but is most common in the lumbar spine. Open laminectomy and minimally invasive laminectomy (MIL) procedures are the most common surgical gold standard techniques for treating LSS. This study aims to review clinical and biomechanical literature to draw comparisons between open laminectomy and various MIL techniques. The MIL variation comprises microendoscopic decompression laminotomy, unilateral partial hemilaminectomy, and microendoscopic laminectomy. A review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We reviewed 25 clinical, 6 finite element, and 3 cadaveric studies associated with treating LSS. We reviewed literature that discusses factors such as operation time, length of hospital stay, postoperative complications, reoperation rate, effect on elderly patients, patients' satisfaction, and adjacent segment disease degeneration for the clinical studies, whereas the range of motion (ROM), von Mises stresses, and stability was compared in biomechanical studies. MIL involves less bone and ligament removal, resulting in shorter hospital stays and lower reoperation and complication rates than open laminectomy. It improves the quality of health-related living standards and reduces postoperative pain. Biomechanical studies suggest that laminectomy and facetectomy increase annulus stress and ROM, leading to segmental instability. Although theoretically, MIL means less tissue injury, pain, and faster recovery in the short term, the long-term results depend on the adequacy of the decompression procedure and tend to be independent of MIL or open laminectomy.

Research progress of different minimally invasive spinal decompression in lumbar spinal stenosis

To review the application and progress of different minimally invasive spinal decompression in the treatment of lumbar spinal stenosis (LSS). The domestic and foreign literature on the application of different minimally invasive spinal decompression in the treatment of LSS was extensively reviewed, and the advantages, disadvantages, and complications of different surgical methods were summarized. At present, minimally invasive spinal decompression mainly includes microscopic bilateral decompression, microendoscopic decompression, percutaneous endoscopic lumbar decompression, unilateral biportal endoscopy, and so on. Compared with traditional open surgery, different minimally invasive spinal decompression techniques can reduce the operation time, intraoperative blood loss, and postoperative pain of patients, thereby reducing hospital stay and saving treatment costs. The indications of different minimally invasive spinal decompression are different, but there are certain advantages and disadvantages. When patients have clear surgical indications, individualized treatment plans should be formulated according to the symptoms and signs of patients, combined with imaging manifestations.

Increased Surgical Experience in Microendoscopic Spinal Surgery Can Reduce Development of Postoperative Spinal Epidural Hematoma and Improve the Clinical Outcomes.

No reports have previously evaluated the association between surgical technique and the incidence of postoperative spinal epidural hematoma (PSEH) following microendoscopic decompression surgery (MED). This study aimed to evaluate the association between the development of radiographic PSEH (rPSEH) following MED and microendoscopic surgical experience and postoperative clinical outcomes related to the quality of life (QoL). This retrospective cohort study included 3922 patients who had undergone MED performed by a single surgeon. rPSEH was defined as a hematoma that was identified via routine magnetic resonance images performed 3-4 days postoperatively. Patients were divided into rPSEH and control groups to identify the risk factor of rPSEH and assess clinical outcomes. In the multivariate analysis, age (p = 0.002), surgical experience (p = 0.003), surgical time (p = 0.038), multilevel decompression (p &lt; 0.001), and diagnosis (p = 0.004) were identified as independent variables associated with rPSEH. Moreover, in mixed-effect models, the rPSEH group showed less improvement in Oswestry Disability Index (p = 0.014) than the control group. In conclusion, the surgical experience was identified as a risk factor for rPSEH that could lead to poor QoL. The sharing of microendoscopic surgical techniques among surgeons may reduce rPSEH incidence and improve patients' QoL.

Long-Term Outcomes after Selective Microendoscopic Laminotomy for Multilevel Lumbar Spinal Stenosis with and without Remaining Radiographic Stenosis: A 10-Year Follow-Up Study.

Long-term clinical outcomes of microendoscopic laminotomy (MEL) for patients with multilevel radiographic lumbar spinal canal stenosis (LSS) have not been widely explored. The clinical significance and natural progression of additional untreated levels (e.g., remaining radiographic (RR)-LSS not addressed by selective MEL) remain unknown. This retrospective study aimed to investigate the long-term clinical outcomes of selective MEL in LSS patients and compare outcomes between patients with and without remaining RR-LSS to determine the efficacy of this procedure. Forty-nine patients at a single center underwent posterior spinal microendoscopic decompression surgery for neurogenic claudication or radicular leg pain in moderate-to-severe spinal stenosis. The patients were categorized into the RR-LSS-positive and RR-LSS-negative cohorts based on unaddressed levels of stenosis. Pre-operative and 10-year follow-up evaluations, including the Japanese Orthopedic Association (JOA) score, visual analog scale (VAS) score for low back pain and leg pain, Oswestry Disability Index (ODI), and satisfaction, were compared between the groups. Additionally, the need for reoperation was determined. MEL significantly improved JOA scores, lumbar VAS, and ODI over the 10-year postoperative period. Pre-operative characteristics and postoperative outcomes were not significantly different between the cohorts. Overall, 18.4% (9/49) of patients required reoperation during the follow-up period. The reoperation rate in the RR-LSS-positive (13.8%; 4/29) group was similar to that in the RR-LL-negative (15.0%; 3/20) group. MEL is effective for lumbar stenosis, with improved clinical outcomes up to 10 years following surgery. Selective MEL, addressing only symptomatic levels in multilevel stenosis, with residual remaining lumbar stenosis, is similarly effective without increased reoperation rates. Surgeons may consider more limited selective decompression in patients with multilevel stenosis, avoiding the risk and invasiveness of extensive procedures. Level III.

Incidence of postoperative progressive segment degeneration at decompression and adjacent segments after minimally invasive lumbar decompression surgery: a 5-year follow-up study.

There are several reported studies on the incidence of adjacent segment disease (ASD) after lumbar fusion surgery; however, the incidence of ASD after decompression surgery has not been well studied. In this study the authors aimed to investigate the incidence of progressive segment degeneration (PSD) at the decompression and adjacent segments 5 years after minimally invasive lumbar decompression surgery. We investigated data from 168 patients (mean age, 69.5 ± 9.2 years) who underwent bilateral microscopic or microendoscopic decompression surgery via a unilateral approach and were followed up for more than 5 years. Outcomes were self-reported visual analog scale (VAS) scores for low-back pain, leg pain, and leg numbness and physician-assessed Japanese Orthopaedic Association (JOA) scores for back pain. Changes in the disc height and movement of the adjacent lumbar segments were compared using preoperative and 5-year postoperative lateral full-length standing whole-spine radiographic images. PSD was defined as loss of disc height > 3 mm and progression of anterior or posterior slippage > 3 mm. The incidence and clinical impact of PSD were investigated. The mean JOA score improved significantly in all patients from 13.4 points before surgery to 24.1 points at the latest follow-up (mean recovery rate 67.8%). PSD at the decompression site was observed in 43.5% (73/168) of the patients. The proportions of patients with loss of disc height > 3 mm and slippage progression were 16.1% (27/168) and 36.9%, respectively (62/168: 41 anterior and 21 posterior). The proportion of patients with PSD at the adjacent segment was 20.5% (35/168), with 5.4% (9/168) of the patients with loss of disc height > 3 mm and 16.0% (27/168: 13 anterior and 14 posterior) with slippage progression. There was no significant difference in the clinical outcomes between patients with and those without PSD. Radiological ASD was observed even in the case of decompression surgery alone. However, there was no correlation with symptom deterioration, measured by the VAS and JOA scores.

Microendoscopic Decompression for Lumbar Disc Herniations: An Analysis of Short and Long Term Patient Reported Outcome Measures.

Endoscopic spine surgery is increasingly being used, and techniques, platforms, and applications are rapidly evolving. Despite substantial enthusiasm surrounding these techniques, there is a dearth of longer term patient-reported clinical outcomes. Within the United States in particular, there are yet to be reported large cohort studies with a notable follow-up. We sought to characterize the clinical outcomes of patients undergoing microendoscopic decompression (MED) for lumbar disk herniations. The records of patients with symptomatic lumbar disk herniations who underwent MED from May 2018 to February 2021 within a single practice were reviewed. Paired outcomes scores were evaluated using Patient-Reported Outcomes Measurement Information System parameters. Basic perioperative data including length of stay, estimated blood loss, mean opioid use, complication rate, and rate of revision were tabulated. Paired sample Student t-tests and paired Wilcoxon sign tests were used to compare normally distributed and nonparametric data, respectively. Thirty-five patients with complete paired patient-reported outcome measures data and a minimum 6-month follow-up were included; 65.7% of the patients were male with a mean age of 47.1 years (SE 1.8). The mean follow-up was 590.6 days (SE 47.7). In total, 34 of the 35 patients (97.1%) were discharged on the day of their procedure. The estimated blood loss was <25 mL for each procedure. The mean opioid use after extubation and before discharge was 10.4 morphine milligram equivalents. At the 2-week follow-up, there were notable improvements in pain metrics and global health components. At the final follow-up, nearly all parameters showed notable improvement that exceeded minimally clinical important difference values. For most parameters, preoperative values outside of the "normal" range were within normal limits on postoperative testing. MED resulted in sustained notable improvement in patient-reported outcome measures that exceeded minimally clinical important difference values at the average follow-up approximating 2 years. These findings substantiate the utility of this technique and additional investment in endoscopic spine technology. Not publicly available; available upon request.

Microendoscopic Lumbar Posterior Decompression Surgery for Lumbar Spinal Stenosis: Literature Review.

Lumbar spinal stenosis (LSS) is a common disease in the elderly, mostly due to degenerative changes in the lumbar spinal complex. Decompression surgery is the standard surgical treatment for LSS. Classically, total laminectomy—which involves resection of the spinous process, entire laminae and medial facet—has been the standard decompression technique; however, it can cause post-surgical instability. To overcome this disadvantage, various minimally invasive techniques that preserve the stabilization structures of the spine have been developed, and surgeons have begun to re-evaluate decompression surgery from the standpoint of reduced invasiveness and cost. More than two decades have passed since the introduction of microendoscopic spine surgery, and studies continue to shed light on its advantages and limitations as new knowledge becomes available. This article is a narrative review of the available literature, along with authors’ experience, regarding the indications, surgical techniques, clinical outcomes, and limitations/complications of microendoscopic decompression for LSS.

THE IMPACT OF MICROENDOSCOPIC DECOMPRESSION ON LOW BACK PAIN IN PATIENTS WITH DEGENERATIVE LUMBAR SPONDYLOLISTHESIS

The same surgeon used microendoscopic decompression (MED) for all 70 patients with degenerative lumbar spondylolisthesis (DS). During the same period, fusion was not performed. Clinical outcomes were evaluated by the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and visual analogue scale (VAS). Standing maximal flexion-extension lateral radiographs were obtained before and after MED to measure the intervertebral angles and percentages of slipping. The mean duration of follow-up was 47.5 months. The effectiveness rate of low back pain (LBP) was the highest among all five functional scores of the JOABPEQ. LBP, pain and numbness in the buttocks and lower limb as measured by the VAS were significantly improved on follow-up evaluation. Improvements in LBP were significantly correlated with improvements in all other functional scores of the JOABPEQ and with improvements in pain and numbness in the buttocks and lower limb scores of the VAS. However, neither spondylolisthesis nor motion on flexion/ extension (MFE) before and after MED influenced the improvement in LBP and the LBP after MED. The presence of LBP before MED did not lead to poor outcomes. Residual LBP was not related to residual spondylolisthesis or MFE or the development of increased spondylolisthesis postoperatively; however, residual LBP was significantly related to other residual disturbances.

Microendoscopic Decompression for Lumbar Spinal Stenosis Associated with Adjacent Segment Disease following Lumbar Fusion Surgery: 5-year Follow-up of a Retrospective Case Series.

Surgical treatment options for lumbar spinal stenosis (LSS) based on adjacent segment disease (ASD) after spinal fusion typically involve decompression, with or without fusion, of the adjacent segment. The clinical benefits of microendoscopic decompression for LSS based on ASD have not yet been fully elucidated. We aimed to investigate the clinical results of microendoscopic spinal decompression surgery for LSS based on ASD. From 2011 to 2014, consecutive patients who underwent microendoscopic spinal decompression without fusion for LSS based on ASD were enrolled. Data of 32 patients (17 men and 15 women, with a mean age of 70.5 years) were reviewed. Japanese Orthopaedic Association score and low back pain/leg pain visual analog scale score were utilized to measure neurologic and axial pain outcomes, respectively. Additionally, after the surgeries, we analyzed the magnetic resonance imaging (MRI), computed tomography (CT) scans, or radiographs to identify any new instabilities of the decompressed segments or progression of ASD adjacent to the decompressed segments. The Japanese Orthopaedic Association recovery rate at the 5-year postoperative visit was 49.2%. The visual analog scale scores for low back pain and leg pain were significantly improved. The minimum clinically important difference for leg pain (decrease by ≥24 mm) and clinically important difference for low back pain (decrease by ≥38 mm) were achieved in 84% (27/32) and 72% (23/32) of cases, respectively. Regarding new instability after microendoscopic decompression, no cases had apparent spinal instability at the decompression segment and adjacent segment to the decompressed segment. Microendoscopic spinal decompression is an effective treatment alternative for patients with LSS caused by ASD. The ability to perform neural decompression while maintaining key stabilizing structures minimizes subsequent clinical instability. The substantial clinical and economic benefits of this approach may make it a favorable alternative to performing concurrent fusion in many patients.

Long-term reoperation rates and causes for reoperations following lumbar microendoscopic discectomy and decompression: 10-year follow-up

ObjectiveTo investigate the 10-year rates and causes of reoperations following lumbar microendoscopic discectomy for disc herniation (MEDH) and microendoscopic decompression for spinal stenosis (MEDS), as well as to define the reoperations at index and different lumbar levels. MethodsBetween June 2005 and May 2011, the same surgeon had been using MEDH and/or MEDS on 355 consecutive patients. The follow-up rate was 88.3%. The causes and rates of reoperations (RORs) were determined at 10 years after the initial operations. ResultsThe 10-year reoperation rate for all patients combined was 22.1% (67/303). The 10-year reoperation rate for all cases that underwent repeat operations in the same segment was 16.5% (50/303); the most frequent reason for reoperation (FRR) was recurrence of disc herniation (ROR, 25/251 = 9.96%), the second FRR was an increase of postoperative spondylolisthesis and/or instability (ROR, 8/303 = 2.64%), and the third FRR was surgical site infection (ROR, 5/303 = 1.65%). Ten-year reoperation rate for all cases that underwent repeat operation at different lumbar levels was 5.61% (17/303); the most FRR was new disc herniation at another lumbar level (ROR, 10/303 = 3.30%), the second FRR was residual segmental stenosis (ROR, 4/303 = 1.32%), and the third FRR was new segmental stenosis at other lumbar levels (ROR, 2/303 = 0.66%). ConclusionsThree-fourths of all repeat operations were conducted in the same segment and one-fourth were performed at different lumbar levels. We believe that it is important to understand and prevent related problems.

Comparison between microendoscopic laminectomy and open posterior decompression surgery for single-level lumbar spinal stenosis: a multicenter retrospective cohort study

BackgroundMicroendoscopic laminectomy (MEL), in which a 16-mm tubular retractor with an internal scope is used, has shown excellent surgical results for patients with lumbar spinal canal stenosis. However, no reports have directly compared MEL with open laminectomy. This study aimed to elucidate patient-reported outcomes (PROs) and perioperative complications in patients undergoing MEL versus open laminectomy.MethodsThis is a multicenter retrospective cohort study of prospectively registered patients who underwent lumbar spinal surgery at one of the six high-volume spine centers between April 2017 and September 2018. A total of 258 patients who underwent single posterior lumbar decompression at L4/L5 were enrolled in the study. With regard to demographic data, we prospectively used chart sheets to evaluate the diagnosis, operative procedure, operation time, estimated blood loss, and complications. The follow-up period was 1-year. PROs included a numerical rating scale (NRS) for lower back pain and leg pain, the Oswestry Disability Index (ODI), EuroQol 5 Dimension (EQ-5D), and patient satisfaction with the treatment.ResultsOf the 258 patients enrolled, 252 (97%) completed the 1-year follow-up. Of the 252, 130 underwent MEL (MEL group) and 122 underwent open decompression (open group). The MEL group required a significantly shorter operating time and sustained lesser intraoperative blood loss compared with the open group. The MEL group showed shorter length of postoperative hospitalization than the open group. The overall complication rate was similar (8.2% in the MEL group versus 7.7% in the open group), and the revision rate did not significantly differ. As for PROs, both preoperative and postoperative values did not significantly differ between the two groups. However, the satisfaction rate was higher in the MEL group (74%) than in the open group (53%) (p = 0.02).ConclusionsMEL required a significantly shorter operating time and resulted in lesser intraoperative blood loss compared with laminectomy. Postoperative PROs and complication rates were not significantly different between the procedures, although MEL demonstrated a better satisfaction rate.

Improving effect of microendoscopic decompression surgery on low back pain in patients with lumbar spinal stenosis and predictive factors of postoperative residual low back pain: a single-center retrospective study

BackgroundAlthough there are reports on the effectiveness of microendoscopic laminotomy using a spinal endoscope as decompression surgery for lumbar spinal stenosis, predicting the improvement of low back pain (LBP) still poses a challenge, and no clear index has been established. This study aimed to investigate whether microendoscopic laminotomy for lumbar spinal stenosis improves low back pain and determine the preoperative predictors of residual LBP.MethodsIn this single-center retrospective study, we examined 202 consecutive patients who underwent microendoscopic laminotomy for lumbar spinal stenosis with a preoperative visual analog scale (VAS) score for LBP of ≥40 mm. The lumbar spine Japanese Orthopaedic Association (JOA), and VAS scores for LBP, leg pain (LP), and leg numbness (LN) were examined before and at 1 year after surgery. Patients with a 1-year postoperative LBP-VAS of ≥25 mm composed the residual LBP group. The preoperative predictive factors associated with postoperative residual LBP were analyzed.ResultsJOA scores improved from 14.1 preoperatively to 20.2 postoperatively (p < 0.001), LBP-VAS improved from 66.7 to 29.7 mm (p < 0.001), LP-VAS improved from 63.8 to 31.2 mm (p < 0.001), and LN-VAS improved from 63.3 to 34.2 mm (p < 0.001). Ninety-eight patients (48.5%) had a postoperative LBP-VAS of ≥25 mm. Multiple logistic regression analysis revealed that Modic type 1 change (odds ratio [OR], 5.61; 95% confidence interval [CI], 1.68–18.68; p = 0.005), preoperative VAS for LBP ≥ 70 mm (OR, 2.19; 95% CI, 1.17–4.08; p = 0.014), and female sex (OR, 1.98; 95% CI, 1.09–3.89; p = 0.047) were preoperative predictors of residual LBP.ConclusionMicroendoscopic decompression surgery had an ameliorating effect on LBP in lumbar spinal stenosis. Modic type 1 change, preoperative VAS for LBP, and female sex were predictors of postoperative residual LBP, which may be a useful index for surgical procedure selection.

Letter to the Editor Regarding “Long-Term Outcomes Following Lumbar Microendoscopic Decompression for Lumbar Spinal Stenosis With and Without Degenerative Spondylolisthesis: Minimum 10-Year Follow-Up”

Letter to the Editor Regarding “Long-Term Outcomes Following Lumbar Microendoscopic Decompression for Lumbar Spinal Stenosis With and Without Degenerative Spondylolisthesis: Minimum 10-Year Follow-Up”

In Reply to the Letter to the Editor Regarding “Long-Term Outcomes Following Lumbar Microendoscopic Decompression for Lumbar Spinal Stenosis with and without Degenerative Spondylolisthesis: Minimum 10-Year Follow-Up”

In Reply to the Letter to the Editor Regarding “Long-Term Outcomes Following Lumbar Microendoscopic Decompression for Lumbar Spinal Stenosis with and without Degenerative Spondylolisthesis: Minimum 10-Year Follow-Up”

Effectiveness of a Gelatin-Thrombin Matrix Sealant (Floseal®) for Reducing Blood Loss During Microendoscopic Decompression Surgery for Lumbar Spinal Canal Stenosis: A Retrospective Cohort Study.

Retrospective cohort study. To investigate the effectiveness and safety of a gelatin-thrombin matrix sealant (GTMS) during microendoscopic laminectomy (MEL) for lumbar spinal canal stenosis (LSCS). This study included 158 LSCS cases on hemostasis-affecting medication who underwent MEL by a single surgeon between September 2016 and August 2020. Patients were divided into 2 groups depending on whether GTMS was used (37 cases, Group A) or not (121 cases, Group B). Perioperative data related to bleeding or postoperative spinal epidural hematoma (PSEH) was investigated. Clinical outcomes were evaluated using the Japanese Orthopedic Association (JOA) score for low back pain. The mean intraoperative blood loss per level was greater in Group A (26.0 ± 20.3 g) than in Group B (13.6 ± 9.0 g), whereas the postoperative drainage volume was smaller in Group A (79.1 ± 42.5 g) than in Group B (97.3 ± 55.6 g). No revision surgeries for PSEH were required in Group A, while 2 (1.7%) revisions were required in Group B (P = .957). The median JOA score improved significantly from the preoperative period to 1-year postoperatively in both Group A and B (total score, 16.0-23.5 and 17.0-25.0 points, respectively). The use of GTMS during MEL for LSCS may be associated with a reduction in postoperative drainage volume. The revision rate for PSEH was not affected significantly by the use of GTMS. Clinical outcomes (represented by the JOA score) were significantly improved after the surgery, regardless of GTMS use during MEL.

Predictors for clinical outcomes of tubular surgery for endoscopic decompression in selected patients with lumbar spinal stenosis.

The success rate of decompression surgery for lumbar spinal stenosis (LSS) has been reported to vary from 60 to 80%. The purpose of this study was to analyze the predictors for clinical outcomes after tubular surgery for endoscopic decompression (microendoscopic decompression) for LSS. A total of 100 patients with degenerative LSS (M/F: 61/39, Age: mean 69.7years), who underwent microendoscopic decompression and had a minimum 2-year follow-up (FU) after surgery, were reviewed. All patients suffered from leg-related symptoms predominantly without severe mechanical back pain, preoperatively. The presence of chronic arterial occlusion of the lower limbs was ruled out. The primary outcome measure was clinical evaluation at 2-year FU using the Oswestry Disability Index (ODI). Furthermore, numeric rating scales, Japanese Orthopedic Association (JOA) lumbar score and JOA Back Pain Evaluation Questionnaire were used for secondary outcome measures. Based on findings of univariable analyses, multivariable logistic regression analysis was applied to identify preoperative predictors for the clinical outcomes. Sixty-eight patients (68%) were assessed as good outcomes, on the basis of minimum clinically important difference of the ODI (13 points ≤) and final ODI score (< 30 points). The secondary outcomes were further support for the primary outcome. In multivariable logistic regression analysis, co-existence of intradiscal vacuum phenomenon with LSS (odds ratio [OR] 8.26; 95% confidence interval [95% CI] 2.32-29.34; p = 0.001) and ischemic cardiovascular comorbidities (OR, 13.3; 95% CI, 1.9-92.57; p = 0.009) were significantly associated with poor clinical outcomes. We found co-existence of intradiscal vacuum phenomenon with LSS and ischemic cardiovascular comorbidity to be preoperative predictors of less favorable clinical outcomes after microendoscopic decompression in selected patients of LSS. Although the conclusion obtained from restricted state, the information would be able to help in patient selection of the tubular surgery for endoscopic decompression for LSS.

Facet cyst after microendoscopic decompression for lumbar spinal stenosis

Facet cyst after microendoscopic decompression for lumbar spinal stenosis