Percutaneous Endoscopic Unilateral-Approach Bilateral Decompression for Lumbar Spinal Stenosis

Summary

The present protocol describes the steps and key points of lumbar endoscopic unilateral laminotomy for bilateral decompression for the treatment of degenerative lumbar spinal stenosis.

Abstract

Lumbar spinal stenosis (LSS) involves the narrowing of the spinal canal due to degenerative changes in the vertebral joints, intervertebral discs, and ligaments. LSS encompasses central canal stenosis (CCS), lateral recess stenosis (LRS), and intervertebral foramen stenosis (IFS). The utilization of lumbar endoscopic unilateral laminotomy for bilateral decompression (LE-ULBD) has gained popularity in the treatment of CCS and LRS. This popularity is attributed to the rapid development of endoscopic instruments and the progress of endoscopic philosophy.

In this technical report, a detailed introduction to the steps and key points of LE-ULBD is provided. Simultaneously, a retrospective review of 132 consecutive patients who underwent LE-ULBD for central canal and/or lateral recess stenosis was conducted. The outcomes after more than two years of follow-up were assessed using the visual analogue score (VAS), Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) scores, and the modified MacNab criteria to evaluate surgical efficacy. All 132 patients underwent LE-ULBD successfully. Among them, 119 patients were rated as "excellent," while 13 patients were rated as "good" based on the modified MacNab criteria during the last follow-up. Incidental dural tears occurred in four cases, but there were no post-operative epidural hematomas or infections. The experience demonstrates that LE-ULBD is a less invasive, effective, and safe approach. It can be considered as an alternative option for treating patients with lumbar central canal stenosis and/or lateral recess stenosis.

Introduction

Degenerative lumbar spinal stenosis (DLSS) can result from alterations in bony, discal, capsular, or ligamentary anatomical structures. Clinically, LSS presents with a range of symptoms, including radiating sciatic pain in the legs, neurogenic claudication during ambulation, and sensory disturbances, all of which significantly affect patients' quality of life^1,2,3. An initial conservative management period of two months is the recommended therapeutic approach for LSS. If conservative measures prove ineffective, transitioning to surgical decompression therapy becomes the s....

Protocol

This study was conducted in strict accordance with the protocols established by the Institutional Review Boards of Zhongshan Hospital and Minhang Hospital, both affiliated with Fudan University (approval numbers: 2021-042 and 2021-037-01X, respectively). All participating patients provided informed written consent. Exclusion criteria were rigorously applied: patients with foraminal stenosis, multi-level stenosis, significant instability, a medical history of previous lumbar spine surgical interventions, or those presenti.......

Discussion

With the progressive evolution of percutaneous endoscopic spine surgery and clinicians' profound comprehension of endoscopic procedures, the therapeutic indications for endoscopic lumbar interventions have expanded to encompass all manifestations of LSS, branching out from merely addressing lumbar disc herniation. The spectrum of endoscopic management for LSS includes stenosis decompression, contralateral decompression, and fusion facilitated by endoscopic visualization. An increasing volume of research underscores t.......

Materials

Name	Company	Catalog Number	Comments
Kerrison Rongeur	Joimax GmbH, Karlsruhe, Germany
The endoscopic high-speed diamond burr	NSK-Nakanishi International, Co., Ltd., Osaka, Japan	Primado P200-RA330
The endoscopic surgical system Delta	Joimax GmbH, Karlsruhe, Germany
The radiofrequency probe	Elliquence LLC, Baldwin, New York	Trigger-FlexR Bipolar System
Trephine	Joimax GmbH, Karlsruhe, Germany