<meta charset="utf8"></head><body>Tratamento da estenose espinhal lombar com uma cirurgia minimamente invasiva da coluna vertebral

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	<li>Benini, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Lumbar+spinal+stenosis.+An+overview+50+years+following+initial+description.">Lumbar spinal stenosis. An overview 50 years following initial description.</a> Der Orthopade. 22 (4), 257-266 (1993).</li><li>Cinotti, G., Postacchini, F., Fassari, F., Urso, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Predisposing+factors+in+degenerative+spondylolisthesis:+a+radiographic+and+CT+study.">Predisposing factors in degenerative spondylolisthesis: a radiographic and CT study.</a> International Orthopaedics. 21, 337-342 (1997).</li><li>Torudom, Y., Dilokhuttakarn, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Two+portal+percutaneous+endoscopic+decompression+for+lumbar+spinal+stenosis:+preliminary+study.">Two portal percutaneous endoscopic decompression for lumbar spinal stenosis: preliminary study.</a> Asian Spine Journal. 10 (2), 335 (2016).</li><li>Atlas, S. J., Keller, R. B., Robson, D., Deyo, R. A., Singer, D. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Surgical+and+nonsurgical+management+of+lumbar+spinal+stenosis:+four-year+outcomes+from+the+maine+lumbar+spine+study.">Surgical and nonsurgical management of lumbar spinal stenosis: four-year outcomes from the maine lumbar spine study.</a> Spine. 25 (5), 556-562 (2000).</li><li>Atlas, S. J., Keller, R. B., Wu, Y. A., Deyo, R. A., Singer, D. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Long-term+outcomes+of+surgical+and+nonsurgical+management+of+lumbar+spinal+stenosis:+8+to+10+year+results+from+the+maine+lumbar+spine+study.">Long-term outcomes of surgical and nonsurgical management of lumbar spinal stenosis: 8 to 10 year results from the maine lumbar spine study.</a> Spine. 30 (8), 936-943 (2005).</li><li>Malmivaara, A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Lumbar+spinal+research+group.+surgical+or+nonoperative+treatment+for+lumbar+spinal+stenosis?:+a+randomized+controlled+trial.">Lumbar spinal research group. surgical or nonoperative treatment for lumbar spinal stenosis?: a randomized controlled trial.</a> Spine. 32 (1), 1-8 (2007).</li><li>Parker, S. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cost-effectiveness+of+multilevel+hemilaminectomy+for+lumbar+stenosis-associated+radiculopathy.">Cost-effectiveness of multilevel hemilaminectomy for lumbar stenosis-associated radiculopathy.</a> The Spine Journal. 11 (8), 705-711 (2011).</li><li>Parker, S. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Two-year+comprehensive+medical+management+of+degenerative+lumbar+spine+disease+(lumbar+spondylolisthesis,+stenosis,+or+disc+herniation):+a+value+analysis+of+cost,+pain,+disability,+and+quality+of+life.">Two-year comprehensive medical management of degenerative lumbar spine disease (lumbar spondylolisthesis, stenosis, or disc herniation): a value analysis of cost, pain, disability, and quality of life.</a> Journal of Neurosurgery: Spine. 21 (2), 143-149 (2014).</li><li>Fox, M. W., Onofrio, B. M., Hanssen, A. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+outcomes+and+radiological+instability+following+decompressive+lumbar+laminectomy+for+degenerative+spinal+stenosis:+a+comparison+of+patients+undergoing+concomitant+arthrodesis+versus+decompression+alone.">Clinical outcomes and radiological instability following decompressive lumbar laminectomy for degenerative spinal stenosis: a comparison of patients undergoing concomitant arthrodesis versus decompression alone.</a> Journal of Neurosurgery. 85 (5), 793-802 (1996).</li><li>J&#246;nsson, B., Annertz, M., Sj&#246;berg, C., Str&#246;mqvist, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+prospective+and+consecutive+study+of+surgically+treated+lumbar+spinal+stenosis:+part+II:+five-year+follow-up+by+an+independent+observer.">A prospective and consecutive study of surgically treated lumbar spinal stenosis: part II: five-year follow-up by an independent observer.</a> Spine. 22 (24), 2938-2944 (1997).</li><li>Ghogawala, Z., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laminectomy+plus+fusion+versus+laminectomy+alone+for+lumbar+spondylolisthesis.">Laminectomy plus fusion versus laminectomy alone for lumbar spondylolisthesis.</a> New England Journal of Medicine. 374 (15), 1424-1434 (2016).</li><li>Komp, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bilateral+spinal+decompression+of+lumbar+central+stenosis+with+the+full-endoscopic+interlaminar+versus+microsurgical+laminotomy+technique:+a+prospective,+randomized,+controlled+study.">Bilateral spinal decompression of lumbar central stenosis with the full-endoscopic interlaminar versus microsurgical laminotomy technique: a prospective, randomized, controlled study.</a> Pain Physician. 18 (1), 61 (2015).</li><li>Ito, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Step-by-step+sublaminar+approach+with+a+newly-designed+spinal+endoscope+for+unilateral-approach+bilateral+decompression+in+spinal+stenosis.">Step-by-step sublaminar approach with a newly-designed spinal endoscope for unilateral-approach bilateral decompression in spinal stenosis.</a> Neurospine. 16 (1), 41 (2019).</li><li>Lee, C. W., Yoon, K. J., Jun, J. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Percutaneous+endoscopic+laminotomy+with+flavectomy+by+uniportal,+unilateral+approach+for+the+lumbar+canal+or+lateral+recess+stenosis.">Percutaneous endoscopic laminotomy with flavectomy by uniportal, unilateral approach for the lumbar canal or lateral recess stenosis.</a> World Neurosurgery. 113, e129-e137 (2018).</li><li>McGrath, L. B., White-Dzuro, G. A., Hofstetter, C. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+clinical+outcomes+following+minimally+invasive+or+lumbar+endoscopic+unilateral+laminotomy+for+bilateral+decompression.">Comparison of clinical outcomes following minimally invasive or lumbar endoscopic unilateral laminotomy for bilateral decompression.</a> Journal of Neurosurgery: Spine. 30 (4), 491-499 (2019).</li><li>Pairuchvej, S., Muljadi, J. A., Ho, J. C., Arirachakaran, A., Kongtharvonskul, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Full-endoscopic+(bi-portal+or+uni-portal)+versus+microscopic+lumbar+decompression+laminectomy+in+patients+with+spinal+stenosis:+systematic+review+and+meta-analysis.">Full-endoscopic (bi-portal or uni-portal) versus microscopic lumbar decompression laminectomy in patients with spinal stenosis: systematic review and meta-analysis.</a> European Journal of Orthopaedic Surgery &amp; Traumatology. 30, 595-611 (2020).</li><li>Kim, H. S., Wu, P. H., Jang, I. T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Lumbar+endoscopic+unilateral+laminotomy+for+bilateral+decompression+outside-in+approach:+a+proctorship+guideline+with+12+steps+of+effectiveness+and+safety.">Lumbar endoscopic unilateral laminotomy for bilateral decompression outside-in approach: a proctorship guideline with 12 steps of effectiveness and safety.</a> Neurospine. 17 (Suppl 1), S99 (2020).</li></ol>

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Kerrison Rongeur&#160;</td>
			<td>Joimax GmbH, Karlsruhe, Germany</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>The endoscopic high-speed&#160;diamond burr</td>
			<td>NSK-Nakanishi International, Co., Ltd., Osaka, Japan</td>
			<td>Primado P200-RA330</td>
			<td></td>
		</tr>
		<tr>
			<td>The endoscopic surgical system Delta</td>
			<td>Joimax GmbH, Karlsruhe, Germany</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>The radiofrequency probe</td>
			<td>Elliquence LLC, Baldwin, New York</td>
			<td>Trigger-FlexR Bipolar System</td>
			<td></td>
		</tr>
		<tr>
			<td>Trephine</td>
			<td>Joimax GmbH, Karlsruhe, Germany</td>
			<td></td>
			<td></td>
		</tr>
	</tbody>
</table>

percutaneous endoscopic unilateral-approach bilateral decompression for lumbar spinal stenosis

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&#39; quality of life1,2,3. 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 subsequent recommendation.
Historically, open laminectomy has been the traditional surgical approach for addressing spinal stenosis. Peer-reviewed studies have confirmed its safety and cost-effectiveness, with outcomes showing notable superiority compared to non-surgical interventions4,5,6,7,8. However, the complexities involved in achieving comprehensive bony decompression of neural components can introduce the risk of segmental spinal instability. This may lead to symptom recurrence or a subsequent need for arthrodesis9,10. Distinctively, Ghogawala et al.11 documented that approximately 34% of patients, after undergoing traditional laminectomy for lumbar spinal stenosis with concomitant stable spinal spondylolisthesis, required revision surgery within four years post-operatively.
Over the past five decades, a discernible shift toward minimally invasive spinal surgical procedures has become evident. The overarching objective has been to reduce approach-related tissue disruption and subsequently mitigate post-operative discomfort and disability. This transition aligns seamlessly with the advent and progression of percutaneous endoscopic spine surgery.
Synchronized with advancements in endoscopic technology and a deepened understanding of endoscopic anatomical intricacies, contemporary endoscopic spine surgeons are now equipped to address a spectrum of LSS presentations safely and effectively. Specifically, lumbar endoscopic unilateral laminotomy for bilateral decompression (LE-ULBD) has gained traction as a favored modality for LSS management12,13,14,15,16,17(Figure 1). Paramount benefits of LE-ULBD include minimal incision requirements, avoidance of soft tissue disruption and muscular denervation, along with improved visualization.
Between May 2017 and May 2021, our institution employed the LE-ULBD technique to manage 132 patients with LSS. Relevant technical details and outcomes over a two-year follow-up period are elucidated herein. Based on these findings, LE-ULBD emerges as a minimally invasive, effective, and secure modality, positioning it as a viable alternative therapeutic strategy for patients diagnosed with lumbar central canal stenosis and/or lateral recess stenosis.

<meta charset="utf8"></head><body>Autor em destaque: Escopo do LE-ULBD como uma abordagem segura, eficaz e minimamente invasiva para tratar a estenose espinhal lombar

Descompressão bilateral endoscópica percutânea de abordagem unilateral para estenose espinhal lombar

The present protocol describes the steps and the key points of lumbar endoscopic unilateral laminotomy for bilateral decompression, LE-ULBD. This technique is used to treat degenerative lumbar spinal stenosis. The paramount advantage is that LE-ULBD provides an unparalleled clear visualization of the surgical field while reducing surgical-related trauma.Endoscopic spine surgery was initially used for lumbar disc herniation. However, it had evolved dramatically in recent years with the rapid development of endoscopic equipment and technological innovations. We have always been committed to broaden the scope of indications of spinal endoscopic technique.For example, we are developing percutaneous full-endoscopic C2 ganglionectomy to treat intractable occipital neuralgia.

Read this Scientific Article Protocol about Percutaneous Endoscopic Unilateral-Approach Bilateral Decompression for Lumbar Spinal Stenosis at JoVE.com

Lumbar spinal stenosis (LSS) involves the narrowing of the spinal canal due to degenerative changes in the vertebral joints, intervertebral discs, and ...

percutaneous-endoscopic-unilateral-approach-bilateral-decompression

Research

JoVE Journal

Medicine

Percutaneous Endoscopic Unilateral-Approach Bilateral Decompression for Lumbar Spinal Stenosis

248 visualizações.  Minhang Hospital, Fudan University. O presente protocolo descreve as etapas e os pontos-chave da laminotomia unilateral endoscópica lombar para descompressão bilateral, LE-ULBD. Esta técnica é usada para tratar a estenose espinhal lombar degenerativa. A vantagem primordial é que o LE-ULBD fornece uma visualização clara incomparável do campo cirúrgico, reduzindo o trauma relacionado à cirurgia.A cirurgia endoscópica da coluna foi inicialmente usada para hérnia de disco lombar....