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Percutaneous transforaminal full endoscopic decompression for the treatment of lumbar spinal stenosis.

ABSTRACT: BACKGROUND:One advantage of an endoscopic approach to treating lumbar spinal stenosis is preservation of spine stability and the adjacent anatomy, and there is a decrease in adjacent segment disc degeneration. The purpose of this study was to discuss the clinical efficacy of percutaneous transforaminal endoscopic decompression for the treatment of lumbar spinal stenosis (LSS). METHODS:This is a retrospective study. From September 2012 to June 2017, 45 patients who were diagnosed with LSS underwent the treatment of percutaneous transforaminal endoscopic decompression (PTED) and were followed up at 1 week, 3 months and 1 year postoperatively. Low back pain and leg pain were measured by Visual Analogue Scale scoring methods (VAS-back and VAS-leg), while functional outcomes were assessed by using the Oswestry Disability Index (ODI). All patients had one-level lumbar spinal stenosis. RESULTS:The most common type of stenosis was lateral recess stenosis (n?=?22; 48.9%), followed by central stenosis (n?=?13; 28.9%) and foraminal stenosis (n?=?10: 22.2%). Regarding comparisons of VAS-back, VAS-leg, and ODI scores before and after operation, VAS and ODI scores significantly improved. The average leg VAS score improved from 7.01?±?0.84 to 2.28?±?1.43 (P?

SUBMITTER: Xie P

PROVIDER: S-EPMC7429717 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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Percutaneous transforaminal full endoscopic decompression for the treatment of lumbar spinal stenosis.

Xie Peigen P Feng Feng F Chen Zihao Z He Lei L Yang Bu B Chen Ruiqiang R Wu Wenbin W Liu Bin B Dong Jianwen J Shu Tao T Zhang Liangming L Chen Chien-Min CM Rong Limin L

BMC musculoskeletal disorders 20200814 1

<h4>Background</h4>One advantage of an endoscopic approach to treating lumbar spinal stenosis is preservation of spine stability and the adjacent anatomy, and there is a decrease in adjacent segment disc degeneration. The purpose of this study was to discuss the clinical efficacy of percutaneous transforaminal endoscopic decompression for the treatment of lumbar spinal stenosis (LSS).<h4>Methods</h4>This is a retrospective study. From September 2012 to June 2017, 45 patients who were diagnosed w ...[more]

PMID: 32799839

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Project description:Background:The indications of different endoscopic and endoscopically assisted translaminar approaches for lumbar spinal stenosis are not well-defined, and validated protocols for the use of the transforaminal over the interlaminar approach are lacking. Methods:We performed a retrospective study employing an image-based patient stratification protocol of stenosis location (type I-central canal, type II-lateral recess, type III-foraminal, type IV-extraforaminal) and clinical outcomes on 249 patients consisting of 137 (55%) men and 112 (45%) women with an average age of 56.03±16.8 years who underwent endoscopic surgery for symptomatic spinal stenosis from January 2013 to February 2019. The average follow-up of 38.27±27.9 months. The primary clinical outcome measures were the Oswestry Disability Index (ODI), Visual Analogue Scale (VAS), and modified Macnab criteria. Results:The frequency of stenosis configuration in decreasing order was as follows: type I-121/249; 48.6%, type III-104/249; 41.8%, type II-15/249; 6%, and type IV-9/249; 3.6%. The transforaminal approach (137/249; 55.0%) was used in most type II to IV lesions followed by the interlaminar approach (78/249; 31.3%), and the full endoscopic approach (12/249; 4.8%), and the endoscopically assisted translaminar approach (8/249; 3.2%) which was exclusively used for type I lesions. Macnab outcomes analysis showed Excellent in 47 patients (18.9%), Good in 178 (71.5%), Fair in 18 (7.2%) and Poor in 6 (2.4%), respectively. Paired two-tailed t-test showed statistically significant VAS (5.46±2.1; P<0.0001) and ODI (37.1±16.9; P<0.0001) reductions as a result of the endoscopic decompression surgery. Cross-tabulation of the Macnab outcomes versus the endoscopic approach and surgical technique confirmed beneficial association of the approach selection with Excellent (P=0.001) and Good (P<0.0001) outcomes with statistically significance. Conclusions:This study suggests that in the hands of skilled endoscopic spines surgeon use of an image-based stenosis location protocol may contribute to obtaining Excellent and Good clinical outcomes in a high percentage (93%) of patients suffering from lumbar stenosis related radiculopathy. Additional comparative studies should examine the prognostic value of choosing the endoscopic approach on the basis of the proposed four-type stenosis protocol by correlating its impact on outcomes with preoperative diagnostic injections and intraoperative direct visualization of symptomatic pain generators under local anesthesia and sedation.

Project description: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.

Project description:BACKGROUND:The objective of this study was to evaluate the clinical effect and correlation between preoperative imaging parameters and the clinical effect of endoscopic transforaminal decompression for lumbar spinal stenosis. METHODS:In this prospective study, 87 patients from Shanxi Province People's Hospital met the criteria for lumbar spinal stenosis and were recruited from June 2014 to January 2016. These patients underwent endoscopic transforaminal decompression. The clinical symptoms were evaluated by VAS, ODI, and claudication at 3 and 6?months after surgery. The overall clinical efficacy was evaluated using the MacNab score. Yellow ligament thickness and area of the dural sac were examined by MRI. Bony vertebral canal area, real spinal canal area, nerve root canal bony area, nerve root canal real area, distance between the articular joints, and vertebral canal sagittal diameter were examined by CT. The soft tissue invasion ratio of the vertebral canal and the invasion ratio of the nerve root canal were calculated. Correlations between imaging parameters and age, sex, and clinical efficacy were examined. RESULTS:The MacNab scores were excellent in 47% of cases, good in 34%, generally good in 8%, and poor in 11%. VAS, ODI, and claudication were significantly improved compared with the preoperative values (P?<?0.01). A significant difference was observed between the 71-81?year age group and the other age groups (P?<?0.05). There were good correlations between clinical efficacy and vertebral canal sagittal diameter, distance between the articular joints, soft tissue invasion ratio of the vertebral canal, and invasion ratio of the nerve root canal. CONCLUSION:Treatment of lumbar spinal stenosis by endoscopic transforaminal decompression can achieve good clinical results. This operation is less effective in patients older than 71?years of age. There were positive correlations between clinical efficacy and the vertebral canal sagittal diameter, the articular joints, soft tissue invasion ratio of the vertebral canal, and invasion ratio of the nerve root canal.

Project description:Background:Contained lumbar disc herniations frequently cause back- and leg pain. Clinical outcomes with surgical treatment may be affected by the size and location of the disc herniation. The surgical directly visualized transforaminal endoscopic decompression has gained acceptance and popularity, while the simplified percutaneous laser disc decompression has fallen out of favor in spite of its initial success as a minimally invasive intervention. In an attempt to better understand the durability of both procedures, the authors performed a comparative analysis of clinical outcomes in patients with contained lumbar disc herniations. Methods:The study population was comprised 248 patients consisting of 162 patients in the endoscopy group (group 1) and 86 patients in the laser group (group 2). Primary outcome measures were Macnab criteria. Herniations were classified as large or small. Additional parameters of advanced degeneration of the lumbar motion segment including posterior disc- and lateral recess height of <3 mm were recorded. IBM SPSS 25.0 was used for Kaplan-Meier survival analysis and cross-tabulation of these variables with statistical testing for significant associations. Results:The mean follow-up was 43.5 months. The serial time recorded for Kaplan-Meier analysis ranged from 1.5 to 84 months. The mean age was 53.37 years (standard deviation =14.65 years). The majority of patients had Excellent and Good Macnab outcomes (212/248; 85.5%) regardless of treatment. Fair and Poor results were achieved in another 36 patients (14.5%). There was a higher percentage of Excellent Macnab outcomes in the endoscopy group (94/162; 58.0%) than in the laser group (38/86; 44.2%) at a statistical significant level (P<0.0001). There was a statistically significantly higher percentage of Excellent and Good Macnab outcomes with endoscopic decompression of small paracentral herniations (97.1%; P<0.0001). Percutaneous laser decompression of large central disc herniations was not statistically better than endoscopic surgical decompression (P=0.125). Endoscopic bony and soft tissue decompression was also better than laser at alleviating symptoms in patients with reduced posterior disc- and lateral recess height with 96.7% in patients with reduced disc height of <3 mm and 94% in patients with reduced lateral recess height of <3 mm (P=0.001). Kaplan-Meier (K-M) Survival time showed longer median survival of the treatment benefit for patients who underwent visualized endoscopic surgical decompression (66.0 months) compared to median K-M survival time for percutaneous laser decompression of 17 months (P<0.0001). Conclusions:Transforaminal endoscopic decompression for symptomatic herniated disc is an effective and durable surgical treatment to alleviate sciatica-type and back symptoms in the vast majority of patients with good long-term survival of pain relief for up to six years. Interventional percutaneous non-visualized laser decompression for the same condition may provide favorable outcomes in the short-term with soft protrusions. However, the treatment effect deteriorates much faster with a median survival of 17 months.

Project description:BackgroundLumbar spinal stenosis (LSS) is one of the most frequent indications for spine surgery. Open decompression and fusion surgery was the most common treatment and used to be regarded as the golden standard treatment for LSS. In recent years, percutaneous endoscopic decompression surgery was also used for LSS. However, the effectiveness and safety of percutaneous endoscopic decompression in the treatment of LSS have not been supported by high-level evidence. Our aim is to 1) compare the effectiveness of percutaneous endoscopic decompression surgery and open decompression and fusion for the treatment of LSS. 2) Investigate the prognosis risk factors for LSS. 3) Evaluate the influence of percutaneous endoscopic decompression for the stability of operative level, and degeneration of adjacent level.MethodsIt's a prospective, multicenter cohort study. The study is performed at 4 centers in Beijing. This study plans to enroll 600 LSS patients (300 patients in the percutaneous endoscopic decompression group, and 300 patients in the open decompression and fusion group). The demographic variables, healthcare variables, symptom related variables, clinical assessment (Visual analogue score (VAS), Oswestry disability index (ODI), Japanese Orthopaedic Association score (JOA)), and radiological assessment (dynamic X-ray, CT, MRI) will be collected at baseline visit. Patients will follow up at 3, 6, 12 months. The primary outcome is the difference of improvement of ODI between baseline and 12-month follow-up between the two groups. The secondary outcome is the score changes of preoperative and postoperative VAS, the recovery rate of JOA, MacNab criteria, patient satisfaction, degeneration grade of adjacent level, ROM of operative level and adjacent level, complication rate.DiscussionIn this study, we propose to conduct a prospective registry study to address the major controversies of LSS decompression under percutaneous spinal endoscopy, and investigate the clinical efficacy and safety of percutaneous endoscopic decompression and open decompression in the treatment of LSS.Trial registrationThis study has been registered on clinicaltrials.gov in January 15, 2020 ( NCT04254757 ). (SPIRIT 2a).

Project description:BackgroundLeg pain and back pain after lumbar laminectomy and spinal decompression fusion surgery are common and often related to persistent lumbar foraminal or lateral recess stenosis. Although persistent symptoms often stem from incomplete decompression during the primary index surgery, recurrent symptoms may also be the result of intervertebral cage subsidence due to loss of intervertebral and neuroforaminal height.ObjectiveThe aim of this study was to investigate the feasibility of using the outpatient transforaminal decompression procedure as an alternative to inpatient open procedure in revision decompression surgery, with the intent of minimizing the incidence of perioperative and postoperative surgical complications while reducing both direct and indirect costs of surgical treatment, shortening time to patient postoperative narcotic independence, and shortening time of patient return to daily activities.MethodsA total of 48 patients with conclusive diagnostic imaging and interventional workup underwent endoscopic transforaminal and lateral recess decompression for both persistent or recurrent leg and/or low back pain following previous lumbar laminectomy (22 patients) or decompression fusion surgery (26 patients). In addition to radiographic studies, patients were followed for a minimum of 2 years postoperatively, and clinical outcomes were evaluated with the visual analog scale (VAS), Oswestry Disability Index (ODI), and modified Macnab criteria.ResultsAt final follow-up, patients with single- and 2-level prior surgeries reported an average ODI reduction following their secondary surgery of 44.6%, with an average final score of 14.8. Less favorable ODI score reductions following secondary surgery (23.8%) were reported by patients who had more than one or a complex prior multilevel surgery. According to the modified Macnab criteria, "excellent" and "good" results were obtained with the secondary surgery in 79.1% (38 of 48) of patients with no more than a single 1- or 2-level prior lumbar surgery. The mean VAS score decreased from 7.7 ± 1.8 preoperatively to 2.3 ± 1.1 at final follow-up (P < .01). Fair and poor results with the secondary surgery were seen in 20.9% (10 of 48) of patients with several prior surgeries or complex multilevel previous lumbar surgeries. The level distribution for secondary surgery was as follows: L4-5 segment (26 levels; 54.1%), L5-S1 (14 levels; 29.2%), L3-4 (7 levels; 14.6%), and the L2-3 level (1 level; 2.1%). Postoperative complications were limited to irritation of the dorsal root ganglion, which occurred in 25% (12 of 48) of patients. There were no wound infections, nerve root injuries, foot drop, or admissions to a hospital for further postoperative care. All patients with "excellent" and "good" outcomes measured by modified Macnab criteria, who were working before and after the primary and secondary surgeries (27 of 38), reported earlier return to work after the endoscopic outpatient surgery (2.6 ± 0.8 weeks) than with the prior inpatient open spinal surgery (8.1 ± 4.5 weeks). Based on the 2012 Medicare fee schedule for professional fees, direct costs were 40.6% and indirect costs were 37.1% lower with the secondary endoscopic surgery compared with primary open surgery.ConclusionsTransforaminal decompression is an effective alternative to open revision lumbar spinal surgery to treat symptomatic spinal stenosis after previous lumbar surgery in patients with persistent or recurrent leg and low back pain. It can be safely done in an outpatient setting, while realizing savings in direct and indirect costs.

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Percutaneous transforaminal full endoscopic decompression for the treatment of lumbar spinal stenosis.

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Percutaneous transforaminal full endoscopic decompression for the treatment of lumbar spinal stenosis.

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