Percutaneous Endoscopic Lumbar Decompression Research Articles

Impact of computed tomography/magnetic resonance imaging registration on rehabilitation after percutaneous endoscopic decompression for lumbar stenosis: Retrospective study.

Percutaneous endoscopic lumbar decompression (PELD) shows promise for lumbar spinal stenosis (LSS) treatment, but its use is limited by the disease's complexity and procedural challenges. In this study, the effects of preoperative planning and intraoperative guidance with computed tomography (CT)/magnetic resonance imaging (MRI) registration techniques on PELD for LSS and postoperative rehabilitation outcomes were evaluated. This retrospective study was conducted with data from patients who underwent PELD for LSS between January 2021 and December 2023. Patients were assigned to preoperative CT/MRI registration and control groups. Data collected included the operative time, length of hospital stay, visual analog scale (VAS) scores for low back and leg pain, and the Japanese Orthopaedic Association (JOA) lumbar spine score. Differences between groups were assessed using Student's t test. Data from 135 patients (71 in the CT/MRI registration group, 64 in the control group) were analyzed. The operative time was significantly shorter in the CT/MRI registration group (P = 0.007). At 2 months postoperatively, both groups showed significant reductions in VAS leg and low back pain scores (all P < 0.001) and improvements in the JOA score (both P < 0.001). No complication or death occurred. Preoperatively, pain and JOA scores were similar between groups (P = 0.830, P = 0.470, and P = 0.287, respectively). At 2 months postoperatively, patients in the CT/MRI registration group reported lower leg and low back pain levels (P < 0.001 and P = 0.001, respectively) and had higher JOA scores (P = 0.004) than did patients in the control group. Preoperative CT/MRI registration for PELD for LSS reduced the operative time and VAS pain scores at 2 months and improved JOA scores, demonstrating enhanced effectiveness and safety.

A retrospective comparative study of robot-assisted unilateral biportal endoscopic lumbar decompression and fusion surgery versus percutaneous endoscopic lumbar decompression and fusion surgery.

The objective of this study is to illustrate the advantages of robot-assisted unilateral biportal endoscopy in lumbar decompression fusion and internal fixation surgery. According to the different surgical methods, we divided the 26 patients into 2 groups, robot-assisted unilateral biportal endoscopy for lumbar interbody fusion (R-ULIF) group and percutaneous endoscopic lumbar decompression and interbody fusion (Endo-LIF) group, with a 1:1 ratio. Gender, disease course, lesion site, fluoroscopy times, operative time, blood loss, postoperative hospital stay, screw placement success rate, fusion rate, complications rate, postoperative pain visual analog scale (VAS) (The VAS score is used only to evaluate pain in the lower back and legs.) Oswestry Disability Index (ODI) (The ODI score can serve as a reference indicator for evaluating the effectiveness of treatment for patients with low back pain, and has good responsiveness in assessing patients with chronic low back pain), and MacNab (The MacNab standard is divided into 4 levels: excellent, good, fair, and poor, which can be used to evaluate the therapeutic efficacy of certain spinal surgeries) standard efficacy evaluation were analyzed and compared between the 2 groups. All patients successfully completed the surgery. Compared with the Endo-LIF group, the R-ULIF group had fewer fluoroscopy procedures, less intraoperative blood loss, and shorter postoperative hospital stay (P < .05). The VAS scores and ODI scores of both groups significantly decreased at all-time points (P < .05). The ODI scores of the R-ULIF group were better than the Endo-LIF group at 1 month and 3 months after surgery (P = .017/P = .047), but there was no statistically significant difference between the groups before surgery and 1 week after surgery (P > .05). The efficacy was evaluated using the MacNab criteria at 6 months after surgery. The R-ULIF group has an excellent and good rate of 84.6%, while the Endo-LIF group has an excellent and good rate of 76.9% (P = 1.000). Robot-assisted unilateral biportal endoscopy for lumbar interbody and fusion surgery has shown short-term clinical efficacy in the treatment of lumbar disc herniation combined with lumbar instability, surpassing endoscopic lumbar interbody fusion surgery. Robot-assisted unilateral biportal endoscopy for lumbar interbody and fusion surgery has demonstrated high success rate in screw placement, minimal radiation exposure, less intraoperative blood loss, shorter hospital stay, and thus deserves further clinical promotion.

Comparative study of percutaneous endoscopic lumbar decompression and traditional revision surgery in the treatment of symptomatic adjacent segment degeneration

ObjectiveThe objective of this study is to evaluate and compare the surgical outcomes and complications of Percutaneous Endoscopic Lumbar Decompression (PELD) and traditional revision surgery in treating symptomatic Adjacent Segment Degeneration (ASD). This comparison aims to delineate the advantages and disadvantages of these methods, assisting spine surgeons in making informed surgical decisions.Methods66 patients with symptomatic ASD who failed conservative treatment for more than 1 month and received repeated lumbar surgery were retrospectively collected in the study from January 2015 to November 2018, with the average age of 65.86 ± 11.04 years old. According to the type of surgery they received, all the patients were divided in 2 groups, including 32 patients replaced the prior rod in Group A and 34 patients received PELD at the adjacent level in Group B. Patients were followed up routinely and received clinical and radiological evaluation at 3, 6, 12 months and yearly postoperatively. Complications and hospital costs were recorded through chart reviews.ResultsThe majority of patients experienced positive surgical outcomes. However, three cases encountered complications. Notably, Group B patients demonstrated superior pain relief and improved postoperative functional scores throughout the follow-up period, alongside reduced hospital costs (P < 0.05). Additionally, significant reductions in average operative time, blood loss, and hospital stay were observed in Group B (P < 0.05). Notwithstanding these benefits, three patients in Group B experienced disc re-herniation and underwent subsequent revision surgeries.ConclusionsWhile PELD offers several advantages over traditional revision surgery, such as reduced operative time, blood loss, and hospital stay, it also presents a higher likelihood of requiring subsequent revision surgeries. Future studies involving a larger cohort and extended follow-up periods are essential to fully assess the relative benefits and drawbacks of these surgical approaches for ASD.

Two kinds of percutaneous endoscopic lumbar decompression in the treatment of single level lumbar lateral recess stenosis

To prospectively compare the clinical efficacy and radiographic outcomes between interlaminar percutaneous endoscopic lumbar decompression(IL-PELD) and transforaminar percutaneous endoscopic lumbar decompression(TF-PELD) in the treatment of single-segment lumbar lateral recess stenosis. From April 2018 to July 2021, 85 patients with single-segment lumbar lateral recess stenosis underment percutaneous endoscopic lumbar decompression.There were 44 males and 41 females, aged from 49 to 81 years old with an average of (65.5±8.3) years old, duration of lumbar lateral recess stenosis ranging from 3 to 83 months with an average of (26.7±16.5) months. They were divided into IL-PELD group and TF-PELD group according to the different operation methods. There were 47 patients in the IL-PELD group, including 28 males and 19 females aged from 50 to 80 yeaes old with an average age was (66.7±9.3) years old. The disease duration ranged from 3 to 65 months with an average of (25.7±15.0) months. There were 38 patients in the TF-PELD group, including 16 males and 22 females, aged from 51 to 78 years old with an average of(64.1±7.6) years old. The disease duration ranged from 4 to 73 months with an average of (27.9±18.3) months The operation time, intraoperative blood loss, intraoperative fluoroscopy, hospitalization day and complications of the two groups were recorded. Visual analogue scale (VAS) to evaluate low back pain and lower limb pain, Oswestry disability index(ODI) to evaluate lumbar function in preoperative and postoperative period(1month, 6 months and last follow-up)were recorded. the sagittal diameter of the lateral recess of the responsible intervertebral space in preoperative and 1 week after the operation were recorded. The operation was successfully completed in both groups without serious complications such as vascular injury, dural sac tear and nerve injury. The operation time in IL-PED group(69.3±19.3)min was significantly longer than that in TF-PELD group(57.5±14.5)min (P<0.05). There was no significant difference in the intraoperative blood loss between the two groups (P>0.05). The number of intraoperative fluoroscopy in TF-PELD group (8.8±2.6)times was significantly higher than that in IL-PED group(4.8±1.2)times (P<0.05). The hospitalization days of the two groups were not statistically significant (P>0.05). VAS for low back and lower extremity pain and ODI were (5.1±2.2), (6.9±1.3) scores and (71.4±12.6) % in IL-PELD group, and (4.7±1.8), (6.9±1.3) scores and (68.4±13.9)% in TF-PELD group. In the IL-PELD group, the VAS of low back pain was (2.4±1.5), (1.6±0.8), (1.4±0.9) scores, and the VAS of lower extremity pain was (3.0±1.2), (1.6±0.7), (1.5±1.0) scores, ODI was (32.6±11.9) %, (17.4±6.5) %, (19.3±9.3)%;In TF-PELD group, the VAS of low back pain was (2.6±1.4), (1.5±0.6), (1.4±1.0) scores, and the VAS of lower extremity pain was (2.8±1.2), (1.6±0.6), (1.5±1.2) scores, The ODI was (32.0±11.2) %, (15.0±6.1) %, and (20.0±11.3) %. The VAS and ODI of the two groups at each time point after operation were significantly improved compared with those before operation (P<0.05), but there was no statistically significant difference between the groups (P>0.05), and there was no statistically significant difference in the interaction between different time points and groups (P>0.05). At 1 week after operation, the sagittal diameter of lateral recess in both groups was significantly increased compared with that before operation (P<0.05), but there was no significant difference between the two groups at each time point (P>0.05). According to the modified Macnab criteria, IL-PELD group was rated as excellent in 24 cases, good in 19 cases and fair in 4 cases. In TF-PELD group the results were excellent in 19 cases, good in 15 cases, fair in 3 cases and poor in 1 case. There was no significant difference between the two groups (P>0.05). IL-PELD and TF-PELD can expand the lateral recess in the treatment of single level lumbar lateral recess stenosis, and have achieved good clinical effects.

Comparing the Efficacy and Safety of Unilateral Biportal Endoscopic Decompression with Percutaneous Endoscopic Lumbar Decompression for Lumbar Degenerative Diseases: A Meta-Analysis

Unilateral biportal endoscopic decompression (UBED) offers the advantages of minimal tissue damage, operational flexibility, and clear visualization, positioning it as an innovative and minimally invasive endoscopic technique. Nevertheless, the clinical evidence supporting the use of UBED in the treatment of degenerative lumbar diseases is limited and conflicting. As of October 1, 2023, a comprehensive search was conducted across databases including Web of Science, PubMed, Embase, and the Cochrane Library to identify all published studies on minimally invasive UBED for the treatment of degenerative lumbar diseases. Data pertaining to patient demographics, fluoroscopy time, operative duration, intraoperative hemorrhage, hospitalization length, visual analog scale (VAS) score for back and leg pain, MacNab criteria, Oswestry Disability Index (ODI), and complication rates were extracted. The Newcastle-Ottawa scale was utilized to assess the quality. Twelve articles were included, involving 816 patients. The back VAS score (95% confidence interval [CI]:-0.09-0.07, P= 0.75), MacNab criteria (95% CI: 0.52-2.3, P= 0.82), fluoroscopy time (95% CI:-7.03 to -0.4, P= 0.08), and the incidence of complications (95% CI: 0.5-1.73, P= 0.82) were not significantly different, while the leg VAS score (95% CI: 0.01-0.18, P= 0.03), ODI score (95% CI:-1.03 to -0.09, P= 0.02), operation time (95% CI: 5.76-20.62, P= 0.0005), hospitalization length (95% CI: 0.41-2.76, P= 0.008), and intraoperative hemorrhage (95% CI: 21.92-72.44, P= 0.0003) were significantly different. UBED offers superiority in ODI, flexibility, and visual field clarity. Conversely, percutaneous endoscopic lumbar decompression presents advantages in terms of operation duration, blood loss, hospitalization length, and leg VAS score. These factors should be thoroughly considered when selecting a surgical approach.

Clinical outcome of percutaneous endoscopic lumbar decompression in treatment of elderly patients with lumbar spinal stenosis: a matched retrospective study.

This retrospective cohort study aimed to evaluate the efficacy and safety of percutaneous endoscopic lumbar decompression (PELD) in elderly patients with lumbar spinal stenosis (LSS). A matched retrospective study. The research was conducted in Beijing Chaoyang Hospital, Capital Medical University, China. This study included patients treated with PELD for LSS from September 2016 to September 2020. Patients with LSS aged ≥ 80years were screened according to the inclusion and exclusion criteria as the study group, and then the same number of patients with LSS aged 50-80years were matched according to gender, stenosis type, and surgical segment as the control group. Preoperative patient status was assessed using the Charlson comorbidity index (CCI) and the American Society of Anesthesiologists (ASA) physical status classification score. Clinical outcomes were assessed using the visual analog scale (VAS), Oswestry Disability Index (ODI) scores, modified Macnab criteria, radiological parameters and complication rates. A total of 624 LSS patients met the screening criteria between September 2016 and September 2020, with 47 LSS patients ≥ 80years old serving as the study group. Forty-seven LSS patients aged 50-80years were matched to the study group according to gender, stenosis type, and stenosis segment. The CCI score (1.77 ± 1.67) and ASA classification (2.62 ± 0.74) of the study group were significantly higher than the CCI score (0.66 ± 0.96) and ASA classification (1.28 ± 0.54) of the control group, and the difference was statistically significant. Compared with preoperative data, postoperative ODI, leg pain VAS scores and back pain VAS scores were significantly improved in both groups (p < 0.05). However, no significant difference was found between two groups in preoperative and postoperative ODI, leg pain VAS scores and back pain VAS scores (p > 0.05). The operation time and postoperative hospital stay in control group were significantly lower than those in study (p < 0.05), but there was no significant difference in blood loss between the two groups (p > 0.05). Besides, overall radiological parameters were comparable in elder and younger patients (p > 0.05), and disc height (DH), lumbar lordosis and segmental lordosis decreased after twoyear follow-up in both groups (p < 0.05). In addition, complication rates were similar between the two groups (p > 0.05), and no serious complications and deaths were found. Single-centre retrospective design, non-randomized sample, small sample size. Although elderly LSS patients (≥ 80years old) are less fit and have more comorbidities, satisfactory outcomes can be achieved with PELD, comparable to those of LSS patients < 80years old, and without increased complications.

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.

Identification of preoperative radiological risk factors for reoperation following percutaneous endoscopic lumbar decompression to treat degenerative lumbar spinal stenosis.

This study aimed to identify radiological risk factors associated with reoperation after percutaneous transforaminal endoscopic decompression (PTED) for degenerative lumbar spinal stenosis (DLSS). The preoperative clinical data of 527 consecutive patients with DLSS who underwent PTED were retrospectively reviewed. Overall, 44 patients who underwent reoperation were matched for age, sex, body mass index, and surgical segment to 132 control patients with excellent or good clinical outcomes. Radiological characteristics were compared between the groups using independent sample t-tests and Pearson's chi-square tests. A predictive model was established based on multivariate logistic regression analysis. The analyses revealed significant differences in the presence of lumbosacral transitional vertebra (LSTV, 43.2% vs. 17.4%, p = 0.001), the number of levels with senior-grade disc degeneration (2.57 vs. 1.96, p = 0.018) and facet degeneration (1.91 vs. 1.25 p = 0.002), and the skeletal muscle index (SMI, 849.7 mm2/m2 vs. 1008.7 mm2/m2, p < 0.001) between patients in the reoperation and control groups. The results of the logistic analysis demonstrated that LSTV (odds ratio [OR] = 2.734, 95% confidence interval [CI]:1.222-6.117, p < 0.014), number of levels with senior-grade facet degeneration (OR = 1.622, 95% CI:1.137-2.315, p = 0.008), and SMI (OR = 0.997, 95% CI:0.995-0.999, p = 0.001) were associated with reoperation after PTED. The application of the nomogram based on these three factors showed good discrimination (area under the receiver operating characteristic curve 0.754, 95% CI 0.670-0.837) and good calibration. LSTV, more levels with senior-grade facet degeneration, and severe paraspinal muscle atrophy are independent risk factors for reoperation after PTED. These factors can thus be used to predict reoperation risk and to help tailor treatment plans for patients with DLSS.

Efficacy of Repeat Percutaneous Endoscopic Lumbar Decompression for Reoperation of Lumbar Spinal Stenosis: A Retrospective Study.

To evaluate the efficacy of repeat percutaneous endoscopic lumbar decompression (PELD) in lumbar spinal stenosis (LSS) reoperation. This study included patients with LSS who relapsed following treatment with PELD therapy between March 2017 and March 2020. Visual analog scale (VAS) scores and Oswestry Disability Index (ODI) were analyzed preoperatively, postoperatively at 3, 6, 12, and 24 months, and at final follow-up. The modified MacNab criteria were used to assess clinical effects. All complications were recorded. At a mean follow-up of 3 years, 24 patients with LSS who underwent repeat PELD were identified. The patients' mean operative time was 122.3±29.2 min, blood loss was 12.5±5.3 mL, and mean hospital stay was 7.0±1.9 days. VAS leg-pain score improved from 6.1±1.0 to 2.0±1.2 (P<0.001), VAS back-pain score improved from 6.2±0.8 to 2.1±1.1 (P<0.001), and ODI improved from 68.9±6.0 to 20.9±5.6 (P <0.001). According to the modified MacNab criteria, the good-to-excellent rate was 83.3%. Postoperative complications, including hematoma, nerve root injury, and dural injury, developed in four patients. Repeat PELD for reoperation in patients with LSS has a good clinical effect, and is recommended in routine clinical practice. Careful intraoperative manipulation is recommended to prevent complications.

Retracted: Outcome of Percutaneous Transforaminal Endoscopic Lumbar Decompression for Multisegment Lumbar Spinal Stenosis and the Effect on VAS Scores.

[This retracts the article DOI: 10.1155/2022/9040402.].

Outcome of Percutaneous Transforaminal Endoscopic Lumbar Decompression for Multisegment Lumbar Spinal Stenosis and the Effect on VAS Scores.

Purpose To investigate the efficacy of percutaneous transforaminal endoscopic lumbar decompression (PTED) in the treatment of multisegment lumbar spinal stenosis (LSS) and its effect on VAS scores. Methods 126 patients with multisegment LSS admitted between August 2017 and August 2021 were selected and divided into the PTED group and the traditional open surgery group (TOS group) according to the different treatment methods. There were 70 cases in the PTED group, treated with PTED, and 56 cases in the TOS group, treated with traditional open surgery. The clinical outcomes, the preoperative and postoperative pain visual analogue scale (VAS), the Oswestry disability index (ODI), the SF-36 quality of life questionnaire scores, the perioperative indicators (operative time, days in hospital, intraoperative blood loss), the postoperative complications, and imaging data were compared between the two groups. Results After the operation, the excellent and good rate in the PTED group (91.43%) was significantly higher than that in the TOS group (75.00%) (P < 0.05). At each time after the operation, the VAS and ODI scores of the two groups were lower than those before the operation, and the VAS scores of the PTED group at 1 day and 3 months after operation were lower than those of the TOS group, and the ODI scores of the PTED group at 3 months after operation were lower than those of the TOS group (P < 0.05). 3 months after the operation, the SF-36 scores in both groups were higher than those before the operation, and those in the PTED group were higher than those in the TOS group (P < 0.05). The operation time and days in hospital in the PTED group were shorter than those in the TOS group, and the intraoperative dominant blood loss and recessive blood loss were less than those in the TOS group (P < 0.05). The total incidence of complications in the PTED group (15.71%) was significantly lower than that in the TOS group (32.14%) (P < 0.05). Conclusion Both PTED and traditional open surgery are effective in treating patients with multisegmental LSS, and both show positive postoperative changes in all indicators, but the former has more promising near -term results in improving lumbar spine pain, function and quality of life than the latter, and has the advantages of less trauma, less bleeding, and fewer complications.

Clinical Efficacy of Large-Channel Percutaneous Lumbar Endoscopic Decompression in the Treatment of Lumbar Spinal Stenosis Secondary to Old Compression Fractures

We sought to explore the clinical efficacy of lumbar spinal stenosis (LSS) secondary to old vertebral compression fractures (OVCF) treatment by large-channel percutaneous endoscopic lumbar decompression. Medical data for a total of 17 patients diagnosed with LSS secondary to OVCF and treated with large-channel percutaneous endoscopic lumbar decompression in our institution from January 2019 to January 2021 were collected. The dural sac cross-sectional area and morphologic grading of the magnetic resonance imaging cross-sectional area were recorded. Lumbar spine stability was assessed using the White-Panjabi scoring system. Visual analog scale and Japanese Orthopaedic Association scores were used to evaluate the surgical efficacy, and the SF-36 health questionnaire was used to evaluate the quality of life of patients. Type and probability of complications were also recorded. The operative segments of the enrolled patients were all in the lower lumbar spine. One-year follow-up post operation showed that the dural sac cross-sectional area was significantly enlarged compared with preoperation, and the morphologic grade was significantly improved (P < 0.05). There was no difference in White-Panjabi score between preoperation and postoperation (P > 0.05). Visual analog scale and Japanese Orthopaedic Association scores at each follow-up time point after operation were higher than those before operation and were significantly improved (P < 0.05). The SF-36 health survey score at 1 year after operation was significantly higher than that before operation (P < 0.05). The complication rate was 6%. Large-channel percutaneous lumbar endoscopic decompression has an evident clinical effect in the treatment of LSS secondary to OVCF and has little effect on the stability of the lumbar spine, which is worthy of clinical application.

Short-term effectiveness of precise safety decompression via double percutaneous lumbar foraminoplasty and percutaneous endoscopic lumbar decompression for lateral lumbar spinal canal stenosis: a prospective cohort study

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.

Novel electromagnetic-based navigation for percutaneous transforaminal endoscopic lumbar decompression in patients with lumbar spinal stenosis reduces radiation exposure and enhances surgical efficiency compared to fluoroscopy: a randomized controlled trial.

BackgroundPercutaneous transforaminal endoscopic lumbar decompression (PTELD) is an emerging surgical alternative for treating lumbar spinal stenosis (LSS). However, the foraminoplasty procedure often requires repeated fluoroscopy, and endoscopy just offers a local view. No studies have focused on decreasing radiation exposure with electromagnetic navigation assistance. This study introduces a novel electromagnetic-based navigation (EMN) endoscopic system for PTELD in patients with LSS and compares the results in navigation and fluoroscopy groups.MethodsEighty-eight patients with LSS were randomized into either a navigation (44 patients) or fluoroscopy group. Duration of surgery, cannula placement time, radiation dose, blood loss, intraoperative pain assessment, and postoperative hospitalization stay were evaluated. The clinical outcomes were evaluated using a visual analogue scale (VAS), the Oswestry Disability Index (ODI), 6-minute walk test, and modified Macnab criteria.ResultsEighty-five patients were followed-up for at least 12 months. The duration of surgery and cannula placement time were significantly more efficient in the navigation group (P=0.03 and P<0.001). Intraoperative pain assessment showed significantly less pain in the navigation group (P=0.038). The radiation dose was significantly higher in the fluoroscopy group than the navigation group (P<0.001). The VAS scores for back (P<0.001) and leg (P<0.001) pain improved significantly in both groups after surgery, as did the ODI (P<0.001) scores. Improvements in walking ability and Macnab criteria assessments at the 12-month follow-up, assessed subjective by patient assessments did not differ between the two groups.ConclusionsThe EMN system used in PTELD for patients with LSS compared to fluoroscopy enhances efficiency for foraminoplasty, reduces intraoperative pain and levels of radiation exposure. It results in outcomes comparable with results using fluoroscopy.

Combined Effects of Graded Foraminotomy and Annular Defect on Biomechanics after Percutaneous Endoscopic Lumbar Decompression: A Finite Element Study.

Percutaneous endoscopic technology has been widely used in the treatment of lumbar disc stenosis and herniation. However, the quantitative influence of percutaneous endoscopic lumbar decompression on spinal biomechanics of the L5–S1 lumbosacral segment remains poorly understood. Hence, the objective of this study is to investigate the combined effects on the biomechanics of different grades of foraminotomy and annular defect for the L5–S1 segment. A 3D, nonlinear, detailed finite element model of L4–S1 was established and validated. Changes in biomechanical responses upon stimulation to the intact spine during different degrees of resection were analyzed. Measurements included intervertebral rotation, intradiscal pressure, and the strain of disc structure under flexion, extension, left/right lateral bending, and left/right axial rotation under pure bending moments and physiological loads. Compared with the intact model, under prefollower load, annular defect slightly decreased intervertebral rotation by −5.0% in extension and 2.2% in right axial rotation and significantly increased the mean strain of the exposed disc by 237.7% in all loading cases. For right axial rotation, unilateral total foraminotomy with an annular detect increased intervertebral rotation by 29.5% and intradiscal pressure by 57.6% under pure bending moment while the maximum corresponding values were 9.8% and 6.6% when the degree of foraminotomy was below 75%, respectively. These results indicate that percutaneous endoscopic lumbar foraminotomy highly maintains spinal stability, even if the effect of annular detect is taken into account, when the unilateral facet is not totally removed. Patients should avoid excessive extension and axial rotation after surgery on L5–S1. The postoperative open annular defect may substantially increase the risk of recurrent disc herniation.

Percutaneous Endoscopic Decompression in Lumbar Canal and Lateral Recess Stenosis - The Surgical Learning Curve.

ObjectiveThe purpose of this study is to characterize the learning curve of endoscopic lumbar decompression based on peri- and postoperative parameters and to suggest the potential of full endoscopic decompression as a primary treatment option for lumbar canal and lateral recess stenosis. MethodsThe records of 223 consecutive patients who underwent percutaneous endoscopic decompression by a single surgeon for their lumbar canal and lateral recess stenosis were reviewed. Patients were stratified into group 1 (n=100) and group 2 (n=123), depending on their case number. After the 100th case, the procedural time reached a plateau and subsequent patients were assigned to the second group. Demographics and surgical outcomes, including operative times, change in dural sac dimensions, length of hospital stay, and intraoperative complication rates were compared between the 2 groups. Postoperative clinical outcomes, including the visual analogue scale (VAS), the Oswestry Disability Index (ODI) and reoperation rates were compared between the 2 groups (group 1, n=90; group 2, n=110) by follow-up evaluation. ResultsProcedural times were greater in group 1 than group 2 (group 1, 105.26 minutes; group 2, 67.65 minutes; p<0.05) and they had higher complication rates (group 1, 16% [16 of 100]; group 2, 8.3% [8 of 123]; p<0.05). The length of hospitalization, postoperative improvement in VAS and ODI, and reoperation rates were not different between the groups. In both groups, stenotic spinal canals were effectively decompressed. ConclusionContinued surgical experience was associated with a reduction in operative times and less intraoperative complications. Although the learning curve was steep and additional surgical experience may be needed to overcome the learning curve, percutaneous full endoscopic lumbar decompression is a safe, clinically-feasible, and effective surgical technique and can be adopted as the primary treatment for lumbar canal and lateral recess stenosis.

Transforaminal Percutaneous Endoscopic Lumbar Decompression by Using Rigid Bendable Burr for Lumbar Lateral Recess Stenosis: Technique and Clinical Outcome.

Background Open laminectomy has been regarded as the standard surgical procedure for lumbar lateral recess stenosis during the last decades. Although percutaneous endoscopic lumbar decompression has led to successful results comparable with open decompression, its application in LSS with is still challenging and technically demanding. Here, we report the surgical procedure and preliminary clinical outcomes of transforaminal percutaneous endoscopic lumbar decompression (PELD) by using flexible burr for lumbar lateral recess stenosis. Method A retrospective study was performed for the patients with lumbar lateral recess stenosis receiving PELD by using flexible burr. The indications of surgery were moderate to severe stenosis, persistent neurological symptoms, and failure of conservative treatment. The patients with mechanical back pain, more than grade I spondylolisthesis, or radiographic signs of instability were not included. Before the operation, the transforaminal epidural lidocaine injections were carried out to make the diagnosis more precise and accurate. Radiologic findings were investigated, and visual analog scale (VAS) for back and leg pain, Oswestry Disability Index, and modified Macnab criteria were analyzed at the different time of preoperation, postoperation, 3 months, 6 months, and 12 months. Results The follow-up period was 12 months. The mean VAS scores for back and leg pain immediately improved from 7.9 ± 1.2 to 2.8± 1.3, 2.4 ± 1.0, and 2.3 ± 1.0, respectively. The mean visual analog scale scores (VAS) for back pain and leg pain were significantly improved after PELD. The preoperative ODI dropped from 69.1 ± 7.3 to 25.9 ± 8.7, 25.0± 6.9, and 24.7 ± 6.4, respectively. The final outcome was excellent in 39.6%, good in 47.9%, fair in 8.3%, and poor in 4.17%. 87.5% of excellent-to-good ratio was achieved on the basis of Macnab criteria at postoperative 12 months. The complications were limited to transient postoperative dysesthesia (one case), temporary pain aggravation (six cases), and neck pain during the operation (one case). Conclusion This observation suggests that the clinical outcomes of PELD for lateral recess stenosis were excellent or showed good results. This minimally invasive technique would be helpful in choosing a surgical method for lateral recess stenosis.

Percutaneous Endoscopic Lumbar Decompression for Lumbar Lateral Spinal Canal Stenosis: Classification of Lateral Region of Lumbar Spinal Canal and Surgical Approaches

The purpose of the present study was to provide a new classification of the lateral region of the lumbar spinal canal (LLSC) and evaluate the clinical outcomes of surgical treatment of LLSC stenosis guided by the classification. We developed a new functional classification of the LLSC by dividing the region into 5 zones. Thirty random lumbar imaging studies from patients with single-level LLSC stenosis in our department from January 2015 to June 2015 were evaluated by 3 examiners to validate its reliability. Subsequently, a prospective clinical outcome study of 76 patients with single-level LLSC stenosis from July 2015 to July 2016 with 2-year follow-up available was undertaken. All the patients had undergone either percutaneous endoscopic transforaminal decompression with foraminoplasty or percutaneous endoscopic interlaminar decompression, according to the classification. The clinical outcomes were evaluated using MacNab criteria, and pre- and postoperative leg pain were evaluated using the visual analog scale. We observed a 93.3% agreement among examiners. The mean follow-up duration was 15.6 months (range, 3-24). We found good and excellent outcomes in 93.4% of the patients at the last follow-up examination. The mean preoperative visual analog scale score was 5.72 ± 1.18 (range, 4-9), which had decreased to 1.26 ± 0.81 (range, 0-3) at the third month postoperatively and to 0.78 ± 0.62 (range, 0-1) by the last follow-up visit. Dural tears appeared in 2 patients, and migrated bone had moved into the spinal canal after the surgery in 1 patient. The new classification of LLSC can provide objective criteria for full-endoscopic surgery that could lead to better clinical outcomes.

Percutaneous Endoscopic Lumbar Reoperation for Recurrent Sciatica Symptoms: A Retrospective Analysis of Outcomes and Prognostic Factors in 94 Patients.

Recurrent symptoms of sciatica after previous surgical intervention is a relatively common and troublesome clinical problem. Percutaneous endoscopic lumbar decompression has been proved to be an effective method for recurrent lumbar disc herniation. However, the prognostic factors and outcomes of percutaneous endoscopic lumbar reoperation (PELR) for recurrent sciatica symptoms were still unknown. The purpose of this study was to evaluate the outcomes and prognostic factors of patients who underwent PELR for recurrent sciatica symptoms. From 2009 to 2015, 94 patients who underwent PELR for recurrent sciatica symptoms were enrolled. The primary surgeries include transforaminal lumbar interbody fusion (n= 16), microendoscopic discectomy (n= 31), percutaneous endoscopic lumbar decompression (PELD, n= 17), and open discectomy (n= 30). The mean follow-up period was 36 months, and 86 (91.5%) patients had obtained at least 24 months' follow-up. Of the 94 patients with adequate follow-up, 51 (54.3%) exhibited excellent improvement, 23 (24.5%) had good improvement, and 7 (7.4%) had fair improvement according to modified Macnab criteria. The average re-recurrence rate was 9.6%, with no difference among the different primary surgery groups (PELD, 3/17; microendoscopic discectomy, 2/31; open discectomy, 3/30; transforaminal lumbar interbody fusion, 1/16). There was a trend toward greater rates of symptom recurrence in the primary group of PELD who underwent percutaneous endoscopic lumbar reoperation compared with other groups, but this did not reach statistical significance (P>0.05). Multivariate analysis suggested that age, body mass index, and surgeon level was independent prognostic factors. Obesity (hazard ratio 13.98, 95% confidence interval 3.394-57.57; P < 0.001) was the risk factor affecting re-recurrence according to logistic regression analysis. PELR is a safe and effective treatment for recurrent sciatica symptoms regardless of different primary operation type. Obesity, inferior surgeon level, and patient age older than 40 years were associated with a worse prognosis. Obesity was also a strong and independent predictor of re-recurrence sciatica symptoms after percutaneous endoscopic lumbar decompression.

Percutaneous lumbar foraminoplasty and percutaneous endoscopic lumbar decompression for lateral recess stenosis through transforaminal approach: Technique notes and 2 years follow-up

ObjectiveTo evaluate the outcome and safety of percutaneous lumbar foraminoplasty (PLF) and percutaneous endoscopic lumbar decompression (PELD) with specially designed instrument for lumbar lateral recess stenosis with/without herniated discs (HDs). MethodFrom August of 2011 to August of 2013, 96 patients met the inclusion criteria were treated with PLF-PELD and 85 cases were followed up to 2 years postoperatively. MRI or CT checkup performed in the next morning after operation. Outcomes of symptoms were evaluated by follow-up interviews at 3 months, 6 months, 1year and 2 years after surgery. Low back pain and leg pain were measured by Visual Analog Scale (VAS) score (1–100). Functional outcomes were assessed by using Oswestry Disability Index (ODI) and modified MacNab criteria. ResultTwo years follow-up data were obtained from 85 cases, including 14 cases on unilateral L3-4, 1 case on bilateral L3-4, 49 cases on unilateral L4-5, 3 cases on bilateral L4-5, 12 cases on unilateral L5S1, 1 case on bilateral L5S1, 3 cases on unilateral L3-5 and 2 cases on unilateral L4-S1. So totally 95 lumbar lateral recesses were decompressed. Patients ranged in age from 46–78 years (mean age, 56.7 years), including 36 males and 49 females. 56 cases combined with HDs. Low back pain and leg pain were significantly relieved after surgery in all patients. 3 patients were complicated with dysesthesia in distribution of exiting nerve that was all operated at L5S1. Postoperative MRI/CT examination showed adequate decompression of lateral recess and removal of combined HDs in all patients. No patient had postoperative infection, dysfunctional nerve root injury or iatrogenic segmental instability. 2 cases experienced recurrence of combined HDs (2.4%), but could not undertake further revision surgery because of infirm condition. All the 85 cases were analyzed with complete follow-up data. VAS scores and ODI values were significantly lower in all time-points after surgery than before surgery. MacNab scores at 2 years after surgery were obtained from all the 85 patients. 29 cases were given “excellent”; 48 were given “good”. 6 patients experienced heavier low back pain, thus being classified as “fair”. 2 cases with recurrence were given “poor”. ConclusionsPLF-PELD with specially designed instrument is a less invasive, effective and safe surgery for lumbar lateral recess stenosis with/without combined HDs.