Minimally Invasive Endoscopic Bilateral Decompression with a Unilateral Approach (endo-BiDUA) for Elderly Patients with Lumbar Spinal Canal Stenosis

Abstract

Objectives: Endoscopic spinal surgery has become increasingly common year for year because it is a minimally invasive procedure. In our hospital, we introduced endoscopic bilateral decompression with a unilateral approach (endo-BiDUA) in 2006. In this paper, we review clinically and radiographically the elderly patients who underwent the endo-BiDUA.

Methods: Fifteen patients aged over 65 years were included in this review. They had undergone endo-BiDUA between January 2006 and July 2008. Operation time, blood loss, complications, clinical outcome using the Japanese Orthopedic Association (JOA) score, and enlargement ratio of the dural tube on magnetic resonance imaging (MRI), were evaluated.

Results: The mean operation time per level of endo-BiDUA was 144 min. Blood loss was about 60.2 mL. One patient had a post-surgical hematoma and required an additional laminectomy and removal of the hematoma 2 days after the surgery. No other complications such as dural tear, nerve root injury, or infection were encountered. All patients but one, who had a post-surgical hematoma, could start walking within 2 days following the surgery. Before surgery, the mean JOA score was 17.0 and it improved to about 23.3 after the surgery. The area of the dural tube increased to 408.0% after the surgery (range: 211–774%).

Conclusions: Endo-BiDUA facilitated the return of elderly patients with lumbar spinal canal stenosis to their original daily activities.

Key words

bilateral decompression - endoscopic surgery - minimally invasive surgery - lumbar stenosis

References

• 1 Postacchini F. Spine update: Surgical management of lumbar spinal stenosis.  Spine. 1999;  24 1043-1047
• 2 Joson RM, McCormick KJ. Preservation of the supraspinous ligament for spinal stenosis: a technical note.  Neurosurgery. 1993;  21 420-422
• 3 Young S, Veerapen R, O’Laoire SA. Relief of lumbar canal stenosis using multilevel subarticular fenestration as an alternative to wide laminectomy: preliminary report.  Neurosurgery. 1988;  23 628-633
• 4 McCulloch JA. Microsurgical Spinal Laminotomies. In: The Adult Spine: Principles and Practice. JW Frymoyer, ed. New York: Raven Press, Ltd; 1991
• 5 Weiner BK, Walker M, Brower RS. et al . Microdecompression for lumbar spinal stenosis.  Spine. 1999;  24 2268-2272
• 6 Foley KT, Smith MM. Microendoscopic discectomy.  Techn Neurosurg. 1997;  3 301-307
• 7 Sairyo K, Katoh S, Sakamaki T. et al . A new endoscopic technique to decompress lumbar nerve roots affected by spondylolysis. Technical note.  J Neurosurg. 2003;  98 290-293
• 8 Higashino K, Sairyo K, Katoh S. et al . Minimally invasive technique for direct repair of the pars defects in young adults using a spinal endoscope: Technical note.  Minim Invas Neurosurg. 2007;  50 186-190
• 9 Matsumoto M, Chiba K, Ishii K. et al . Microendoscopic partial resection of the sacral ala to relieve extraforaminal entrapment of the L-5 spinal nerve at the lumbosacral tunnel. Technical note.  J Neurosurg Spine. 2006;  4 342-346
• 10 Sairyo K, Sakai T, Higashino K. et al . Minimally invasive excision of lumbar epidural lipomatosis using a spinal endoscope.  Minim Invas Neurosurg. 2008;  51 43-46
• 11 Adamson TE. Microendoscopic posterior cervical laminoforaminotomy for unilateral radiculopathy: results of a new technique in 100 cases.  J Neurosurg. 2001;  95 51-57
• 12 Guiot BH, Khoo LT, Fessler RG. A minimally invasive technique for decompression of the lumbar spine.  Spine. 2002;  27 432-438
• 13 Atlas SJ, Keller RB, Robson D. et al . Surgical and nonsurgical management of lumbar spinal stenosis: four-year outcomes from the Maine lumbar spine study.  Spine. 2000;  25 556-562
• 14 Katz JN, Stucki G, Lipson SJ. et al . Predictors of surgical outcome in degenerative lumbar spinal stenosis.  Spine. 1999;  21 2229-2233
• 15 Guigui P, Benoist M, Delecourt C. et al . Motor deficit in lumbar spinal stenosis: a retrospective study of a series of 50 patients.  J Spinal Disord. 1998;  11 283-288
• 16 Sihvonen T, Herno A, Paljarvi L. et al . Local denervation atrophy of paraspinal muscles in postoperative failed back syndrome.  Spine. 1993;  18 575-581
• 17 Podichetty VK, Spears J, Isaacs RE. et al . Complications associated with minimally invasive decompression for lumbar spinal stenosis.  J Spinal Disord Tech. 2006;  19 161-166
• 18 Ikuta K, Arima J, Tanaka T. et al . Short-term results of microendoscopic posterior decompression for lumbar spinal stenosis. Technical note.  J Neurosurg Spine. 2005;  2 624-633
• 19 Mayer HM, List J, Korge A. et al . Microsurgery of acquired degenerative lumbar spinal stenosis. Bilateral over-the-top decompression through unilateral approach.  Orthopade. 2003;  32 889-895 [in German]
• 20 Inui A, Sairyo K, Katoh S. et al . Extruded lumbar osseous endplate causing long-term radiculopathy in an adult: an endoscopic excision.  Minim Invas Neurosurg. 2006;  49 55-57
• 21 Tonogai I, Sairyo K, Higashino K. et al . Minimally invasive endoscopic removal of a herniated nucleus pulposus that had migrated to the S1 nerve root foramen.  Minim Invas Neurosurg. 2007;  50 173-177

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