Extent of Decompression of Lumbar Spinal Canal after Endoscopic Surgery

Abstract

Introduction Endoscopic techniques are being used in lumbar disk disease and lumbar canal stenosis to decompress the spinal canal. The present study analyzed pre- and postoperative magnetic resonance imaging (MRI) measurements of the lumbar canal.

Material and Methods This was a prospective study of 30 lumbar levels. Patients < 18 years of age with unilateral compression, previous surgery at the same level, and spinal instability were excluded. Endoscopic posterior decompression was used. Pre- and postoperative MRIs of all the patients were performed. Anteroposterior (AP), transverse, interfacet diameter, canal surface area, and height and angle of the lateral recess were measured.

Results Mean ages of male and female patients were 42.1 ± 10.3 and 45.0 ± 9.9 years, respectively. Pathologies were at L4–L5, L5–S1, and L2–L3 levels in 16, 13, and 1 patient, respectively. There was significant improvement in AP diameter (4.75 ± 1.75 mm to 10.33 ± 2.11 mm), interfacet distance (12.70 ± 4.86 mm to 18.92 ± 3.53 mm), and canal surface area (76.45 ± 25.36 mm² to 187.13 ± 41.04 mm²) after decompression. Significant improvement was noted in mean height and angle of lateral recess after surgery of both sides suggesting that effective decompression of the bilateral canal was possible using a unilateral approach. Most of the patients (90%) showed excellent and good improvement after surgery. Postoperative canal surface area and AP diameter in patients who did not have any pain after surgery or had pain requiring occasional medication was higher compared with patients who continued to complain of pain and required continuous pain medication.

Conclusion Although the number of patients was small with a short follow-up, the endoscopic technique was effective in improving AP diameter, interfacet distance, canal surface area, lateral recess height, and lateral recess angle, suggesting that an endoscopic technique using a unilateral approach is effective in bilateral decompression of neural elements.

Keywords

endoscopic lumbar discectomy - lumbar disk disease - spinal stenosis - spondylosis - surgical decompression

• References

• 1 Komp M, Hahn P, Merk H, Godolias G, Ruetten S. Bilateral operation of lumbar degenerative central spinal stenosis in full-endoscopic interlaminar technique with unilateral approach: prospective 2-year results of 74 patients. J Spinal Disord Tech 2011; 24 (05) 281-287
• 2 Xu BS, Tan QS, Xia Q, Ji N, Hu YC. Bilateral decompression via unilateral fenestration using mobile microendoscopic discectomy technique for lumbar spinal stenosis. Orthop Surg 2010; 2 (02) 106-110
• 3 Yadav YR, Yadav N, Parihar V, Kher Y, Ratre S. Endoscopic posterior decompression of lumbar canal stenosis. Indian J Neurosurg 2013; 2: 124-130
• 4 Yadav YR, Parihar V, Namdev H, Agarwal M, Bhatele PR. Endoscopic interlaminar management of lumbar disc disease. J Neurol Surg A Cent Eur Neurosurg 2013; 74 (02) 77-81
• 5 Zhai XJ, Bi DW, Fu H, Zu G. [Treatment of lumbar disc herniation with lateral recess stenosis by microendoscopic discectomy [in Chinese]. Zhongguo Gu Shang 2008; 21 (02) 120-121
• 6 Enyo Y, Yamada H, Kim JH, Yoshida M, Hutton WC. Microendoscopic lateral decompression for lumbar foraminal stenosis: a biomechanical study. J Spinal Disord Tech 2014; 27 (05) 257-262
• 7 Hara M, Takahashi H, Yokoyama Y, Wada A, Hasegawa K, Iida Y. Comparison of the invasiveness of conventional discectomy and microendoscopic discectomy for lumbar disc herniation: differences in the methods of approach. Asian J Endosc Surg 2015; 8 (01) 40-47
• 8 Smith N, Masters J, Jensen C, Khan A, Sprowson A. Systematic review of microendoscopic discectomy for lumbar disc herniation. Eur Spine J 2013; 22 (11) 2458-2465
• 9 Matsumoto M, Watanabe K, Hosogane N. , et al. Recurrence of lumbar disc herniation after microendoscopic discectomy. J Neurol Surg A Cent Eur Neurosurg 2013; 74 (04) 222-227
• 10 Ruetten S, Komp M, Hahn P, Oezdemir S. Decompression of lumbar lateral spinal stenosis: full-endoscopic, interlaminar technique [in German]. Oper Orthop Traumatol 2013; 25 (01) 31-46
• 11 Polikandriotis JA, Hudak EM, Perry MW. Minimally invasive surgery through endoscopic laminotomy and foraminotomy for the treatment of lumbar spinal stenosis. J Orthop 2013; 10 (01) 13-16
• 12 Yoshimoto M, Miyakawa T, Takebayashi T. , et al. Microendoscopy-assisted muscle-preserving interlaminar decompression for lumbar spinal stenosis: clinical results of consecutive 105 cases with more than 3-year follow-up. Spine 2014; 39 (05) E318-E325
• 13 Sclafani JA, Kim CW. Complications associated with the initial learning curve of minimally invasive spine surgery: a systematic review. Clin Orthop Relat Res 2014; 472 (06) 1711-1717
• 14 Xu H, Liu X, Liu G, Zhao J, Fu Q, Xu B. Learning curve of full-endoscopic technique through interlaminar approach for L5/S1 disk herniations. Cell Biochem Biophys 2014; 70 (02) 1069-1074
• 15 Hsu HT, Chang SJ, Yang SS, Chai CL. Learning curve of full-endoscopic lumbar discectomy. Eur Spine J 2013; 22 (04) 727-733
• 16 Zhou X, Zhang L, Zhang HL. , et al. Clinical outcome and postoperative CT measurements of microendoscopic decompression for lumbar spinal stenosis. Clin Spine Surg 2016 in press
• 17 Wada K, Sairyo K, Sakai T, Yasui N. Minimally invasive endoscopic bilateral decompression with a unilateral approach (endo-BiDUA) for elderly patients with lumbar spinal canal stenosis. Minim Invasive Neurosurg 2010; 53 (02) 65-68
• 18 Destandau J. A special device for endoscopic surgery of lumbar disc herniation. Neurol Res 1999; 21 (01) 39-42
• 19 Oertel JM, Mondorf Y, Gaab MR. A new endoscopic spine system: the first results with “Easy GO”. Acta Neurochir (Wien) 2009; 151 (09) 1027-1033
• 20 Yadav YR, Parihar V, Pande S, Namdev H. Endoscopic management of colloid cysts. J Neurol Surg A Cent Eur Neurosurg 2014; 75 (05) 376-380
• 21 Russo N, Brunori A, Delitala A. Endoscopic approaches to intraventricular lesions. J Neurol Surg A Cent Eur Neurosurg 2015; 76 (05) 353-360
• 22 Yadav YR, Parihar VS, Ratre S, Kher Y. Avoiding complications in endoscopic third ventriculostomy. J Neurol Surg A Cent Eur Neurosurg 2015; 76 (06) 483-494
• 23 Yadav YR, Madhariya SN, Parihar VS, Namdev H, Bhatele PR. Endoscopic transoral excision of odontoid process in irreducible atlantoaxial dislocation: our experience of 34 patients. J Neurol Surg A Cent Eur Neurosurg 2013; 74 (03) 162-167
• 24 Gu Y, Yu Y, Zhang X. , et al. Endoscopic endonasal transmaxillary transpterygoid approach to Meckel cave: anatomical study and preliminary clinical results. J Neurol Surg A Cent Eur Neurosurg 2015; 76 (03) 205-210
• 25 Masopust V, Netuka D, Benes V, Bradac O, Marek J, Hana V. Endonasal endoscopic pituitary adenoma resection: preservation of neurohypophyseal function. J Neurol Surg A Cent Eur Neurosurg 2014; 75 (05) 336-342
• 26 Oshima Y, Takeshita K, Inanami H. , et al. Cervical microendoscopic interlaminar decompression through a midline approach in patients with cervical myelopathy: a technical note. J Neurol Surg A Cent Eur Neurosurg 2014; 75 (06) 474-478
• 27 Hur JW, Kim JS, Cho DY, Shin JM, Lee JH, Lee SH. Video-assisted thoracoscopic surgery under O-arm navigation system guidance for the treatment of thoracic disk herniations: surgical techniques and early clinical results. J Neurol Surg A Cent Eur Neurosurg 2014; 75 (06) 415-421
• 28 Mezzadri J, Abbati SG, Jalon P. Tarlov cysts: endoscope-assisted obliteration of the communication with the spinal subarachnoid space. J Neurol Surg A Cent Eur Neurosurg 2014; 75 (06) 462-466
• 29 Sencer A, Yorukoglu AG, Akcakaya MO. , et al. Fully endoscopic interlaminar and transforaminal lumbar discectomy: short-term clinical results of 163 surgically treated patients. World Neurosurg 2014; 82 (05) 884-890
• 30 Minamide A, Yoshida M, Yamada H. , et al. Endoscope-assisted spinal decompression surgery for lumbar spinal stenosis. J Neurosurg Spine 2013; 19 (06) 664-671
• 31 Guiot BH, Khoo LT, Fessler RG. A minimally invasive technique for decompression of the lumbar spine. Spine 2002; 27 (04) 432-438
• 32 Li SW, Yin HP, Cao ZH, Bai M, Du ZC, Wang YP. Intertransverse approach microendoscopic discectomy for far lateral lumbar disc herniation [in Chinese]. Zhongguo Gu Shang 2014; 27 (09) 752-755
• 33 Hudak EM, Perry MW. Outpatient minimally invasive spine surgery using endoscopy for the treatment of lumbar spinal stenosis among obese patients. J Orthop 2015; 12 (03) 156-159
• 34 Hou T, Zhou Q, Dai F. , et al. Repeated microendoscopic discectomy for recurrent lumbar disk herniation. Clinics (Sao Paulo) 2015; 70 (02) 120-125
• 35 Nomura K, Yoshida M, Kawai M, Okada M, Nakao S. A novel microendoscopically assisted approach for the treatment of recurrent lumbar disc herniation: transosseous discectomy surgery. J Neurol Surg A Cent Eur Neurosurg 2014; 75 (03) 183-188
• 36 Minamide A, Yoshida M, Yamada H. , et al. Clinical outcomes after microendoscopic laminotomy for lumbar spinal stenosis: a 5-year follow-up study. Eur Spine J 2015; 24 (02) 396-403
• 37 Hussein M, Abdeldayem A, Mattar MM. Surgical technique and effectiveness of microendoscopic discectomy for large uncontained lumbar disc herniations: a prospective, randomized, controlled study with 8 years of follow-up. Eur Spine J 2014; 23 (09) 1992-1999
• 38 Yoshimoto M, Takebayashi T, Kawaguchi S. , et al. Minimally invasive technique for decompression of lumbar foraminal stenosis using a spinal microendoscope: technical note. Minim Invasive Neurosurg 2011; 54 (03) 142-146
• 39 Ikuta K, Tono O, Tanaka T. , et al. Surgical complications of microendoscopic procedures for lumbar spinal stenosis. Minim Invasive Neurosurg 2007; 50 (03) 145-149
• 40 Sairyo K, Sakai T, Higashino K, Inoue M, Yasui N, Dezawa A. Complications of endoscopic lumbar decompression surgery. Minim Invasive Neurosurg 2010; 53 (04) 175-178
• 41 Yadav YR, Nishtha Y, Vijay P, Shailendra R, Yatin K. Endoscopic endonasal trans-sphenoid management of craniopharyngiomas. Asian J Neurosurg 2015; 10 (01) 10-16
• 42 Yadav YR, Parihar V, Ratre S, Kher Y, Iqbal M. Microneurosurgical Skills Training. J Neurol Surg A Cent Eur Neurosurg 2016; 77 (02) 146-154