Therapeutic effects of full endoscopic spine surgery via transforaminal approach in elderly patients with lumbar spinal stenosis: A retrospective clinical study

Surgical Outcomes of Full-Endoscopic Degenerative Lumbar Lateral Recess Stenosis Decompression Through an Interlaminar Approach

OBJECTIVE

The conventional open decompression surgery for degenerative lumbar lateral recess stenosis (DLLRS) yields definitive therapeutic outcomes; however, it confronts numerous challenges, including extensive surgical trauma and iatrogenic spinal instability. The purpose of this study is to investigate the surgical outcomes of full-endoscopic DLLRS decompression by an interlaminar approach.

METHODS

A consecutive cohort of 275 patients, including 148 males and 127 females, with an average age of 64.62 (55-82) years, with DLLRS between July 2021 and December 2022, was reviewed in this retrospective study. The involved segments were L4/5 in 126 patients and L5/S1 in 149 patients. The computed tomography (CT) and magnetic resonance imaging (MRI) of the lumbar were examined before and after surgery to evaluate the degree of decompression. The VAS score of back and leg pain and the ODI scale were recorded preoperatively, 1 day, 1, 3, 6, and 12 months after surgery, and at the last follow-up. The modified Macnab score was determined at the last follow-up. One-way analysis of variance (ANOVA) was used to compare the VAS and ODI scores of back/leg pain at various time points before and after surgery.

RESULTS

All of the patients underwent surgery successfully. The average duration of surgery was 84.90 min, the average blood loss was 47.33 mL, and the length of hospitalization was 3-4 (3.31 ± 0.46) days, with no nerve injury, infections, or other complications. One-way ANOVA results showed significantly improved VAS and ODI scores for back/leg pain at each time point after surgery compared to those preoperatively (p < 0.05). The mean follow-up was 23.6 ± 2.3 (range, 15-32) months; at the last follow-up, the modified Macnab was excellent in 143 patients, good in 102 patients, fair in 18 patients, and poor in 12 patients.

CONCLUSION

Full-endoscopic lumbar lateral recess decompression through an interlaminar approach is a safe and effective approach for DLLRS.

Effectiveness of percutaneous key lesion endoscopic lumbar decompression for the treatment of lumbar spinal stenosis in octogenarian patients

INTRODUCTION

With increasing life expectancy, degenerative lumbar spinal stenosis (LSS) has become a common problem in the geriatric population. LSS reduces the quality of life, limits daily activities, and requires therapeutic aids. We share our experiences of treating octogenarian patients with LSS with key lesion percutaneous single portal endoscopic unilateral laminotomy and bilateral decompression (sEndo-ULBD).

MATERIALS AND METHODS

Nine octogenarian patients who underwent sEndo-ULBD between January 2021 and July 2022 were prospectively enrolled in this study. Their visual analogue score (VAS), Oswestry Disability Index (ODI), disc height, spondylolisthesis, lumbar lordotic angle, lumbar scoliotic angle, and spinal canal area before and after sEndo-ULBD were followed up for more than six months.

RESULTS

The VAS score was significantly reduced three months after the operation (p < 0.05). The postoperative ODI scores of all patients improved relative to their preoperative scores; this difference became significant in the third month after the operation (p < 0.05). Index-level disc height did not significantly change after the operation. Spondylolisthesis, lumbar lordotic angle, and lumbar scoliotic angle showed no significant curve progression. The spinal canal area increased markedly after sEndo-ULBD (p <0.05), with no known surgery-related complications.

CONCLUSIONS

Key lesion sEndo-ULBD was an appropriate, safe, and effective treatment for octogenarian patients suffering from degenerative LSS. With an average follow-up of over one year, we did not find any significant progression in spinal curvature or instability. sEndo-ULBD is an ideal alternative to aggressive fusion fixation lumbar surgery for managing degenerative LSS in octogenarian patients with functional disability.

Recompression after percutaneous transforaminal endoscopic decompression for degenerative lumbar spinal stenosis: risk factors and outcomes of two different reoperation procedures

Purpose

To determine the risk factors for recompression after percutaneous transforaminal endoscopic decompression (PTED) for the treatment of degenerative lumbar spinal stenosis (DLSS) and compare the outcomes of PTED and posterior lumbar interbody fusion (PLIF) as revision surgery.

Methods

We retrospectively evaluated 820 consecutive DLSS patients who underwent PTED at our institution. 26 patients developed postoperative recompression and underwent reoperation. In total, 208 patients with satisfactory clinical outcomes were enrolled in the control group. The demographic and imaging data of each patient were recorded. Univariate and multivariate analyses were performed to assess risk factors for recompression. Additionally, patients with recompression were divided into PTED and PLIF groups according to the reoperation procedure. The clinical outcomes of the two groups were compared using independent-sample t-tests.

Results

The grade of surgical-level disc degeneration [odds ratio (OR): 2.551, p = 0.045] and the number of disc degeneration levels (OR: 11.985, p < 0.001) were independent risk factors for recompression after PTED. There was no significant difference in the visual analog score (VAS) and Oswestry disability index (ODI) two weeks postoperatively between the PTED and PLIF groups for surgical treatment. However, the mean VAS of back pain (14.1 vs. 20.5, p = 0.016) and ODI (16.0 vs. 21.8, p = 0.016) of patients in the PLIF group were smaller than those in the PTED group at the final follow-up.

Conclusion

More severe degeneration and degenerated levels indicate a higher recompression rate after PTED. Although both PTED and PLIF could achieve immediate relief postoperatively in the treatment of recompression, the final follow-up results showed that the outcome of PLIF appeared better than that of PTED.

End-points of Decompression of in Lumbar Transforaminal Endoscopic Spine Surgery: A Narrative Review of Objective and Subjective Criteria to Prevent Failures

Objective: Executions of indications/extended indications are associated with higher than normal rates of symptomatic recurrences and treatment failures, especially for novice surgeons incorporating Percutaneous Transforaminal endoscopic lumbar discectomy/decompression (PTELD) techniques. Causes of failures can be manifold and can occur because of a residual or a complete fragment causing persistent compression or associated unaddressed stenosis. To prevent this problem, proper training, multiple instrument inventory, variable techniques are needed with progressive learning. Authors aim to suggest objective and subjective criteria to define end-points/adequacy of decompression (EPD).Methods: PubMed database search was limited to locate only adequacy of decompression of PTELD and thus included specific keywords: “ENDPOINT” OR “ADEQUATE” AND “DECOMPRESSION” AND “TRANSFORAMINAL” AND “ENDOSCOPY”. Authors added their experience to refine and define multiple EPD.Results: In the search we found 12 articles total. Upon reviewing these, we found 7 articles matching our criteria. Cross references of included articles were searched, 5 additional articles were included. EPD were described in only 9 articles. Author’s experience with other relevant references were added to complete the viewpoint (EPD, n=29). Direct observed/ provoked EPD and inferred EPD were defined separately. Videos, illustrations and descriptions of each EPD are illustrated to provide the ideation.Conclusion: EPD are variable and not all signs may be elicited in every case and may change with surgeon experience. The ability to recognize EPD is the crux for successful outcomes and maximum possible EPD’s should be aimed in every surgery to avoid failures.

Complications and risk factors of percutaneous endoscopic transforaminal discectomy in the treatment of lumbar spinal stenosis

Background

With the advancements in surgical methods, optical designs, and surgical instruments, percutaneous endoscopic transforaminal discectomy (PETD) has become an effective and minimally invasive procedure to treat lumbar spinal stenosis (LSS) in recent years. Few studies have focused on the complications associated with the treatment of LSS using percutaneous endoscopic lumbar discectomy (PELD). This study aimed to summarize the complications of PETD and identify the associated risk factors.

Methods

Complications in a total of 738 consecutive LSS patients who underwent single-level PETD were retrospectively recorded and analyzed between January 2016 and July 2020. In addition, a matched case-control study was designed, and according to the date of operation, the control group was matched with patients without complications, with a matching ratio of 1:3. Demographic parameters included age, sex, BMI, smoking and drinking status, comorbidity, and surgical level. The radiological parameters included grade of surgical-level disc degeneration, number of degenerative lumbar discs, grade of lumbar spinal stenosis, degenerative lumbar scoliosis, lumbar lordosis, disc angle, and disc height index. Univariate analysis was performed using independent samples t-test and chi-squared test.

Results

The incidence of different types of complications was 9.76% (72/738). The complications and occurrence rates were as follows: recurrence of LSS (rLSS), 2.30% (17/738); persistent lumbosacral or lower extremity pain, 3.79% (28/738); dural tear, 1.90% (14/738); incomplete decompression, 0.81% (6/738); surgical site infection, 0.41% (3/738); epidural hematoma, 0.27% (2/738); and intraoperative posterior neck pain, 0.27% (2/738). Univariate analysis demonstrated that age, the grade of surgical-level disc degeneration (P < 0.001) and the number of disc degeneration levels (P = 0.004) were significantly related to the complications.

Conclusion

Complications in the treatment of LSS using PELD included rLSS, persistent pain of the lumbosacral or lower extremity, dural tear, incomplete decompression, surgical site infection, epidural hematoma, and intraoperative posterior neck pain. In addition, old age, severe grade of surgical-level disc degeneration and more disc degeneration levels significantly increased the incidence of complications.