Full-Endoscopic Interlaminar Approach for Decompression of Lateral Recess Stenosis

Summary

Technical advances and increased experience in full-endoscopic spinal surgeries enable these procedures to be performed with minimal incision, muscle retraction, and bone removal.

Abstract

For lateral recess stenosis, extensive decompression with laminectomy is still performed in most centers. However, tissue-sparing surgeries are becoming more common. Full-endoscopic spinal surgeries have the advantages of being less invasive and offering a shorter recovery time. Here, we describe the technique of the full-endoscopic interlaminar approach for the decompression of lateral recess stenosis. The full-endoscopic interlaminar approach for the lateral recess stenosis procedure took approximately 51 min (range of 39-66 min). Blood loss could not be measured due to continuous irrigation. However, no drainage was required. There were no dura mater injuries reported in our institution. Furthermore, there were no injuries to the nerves, no cauda equine syndrome, and no hematoma formation. The patients were mobilized on the same day as surgery and discharged the next day. Therefore, the full-endoscopic technique for lateral recess stenosis decompression is a feasible procedure that lowers the operational time, complications, traumatization, and rehabilitation duration.

Introduction

Spinal stenosis, both central and lateral recess stenosis, is the most common pathology in the elderly population¹. Lateral recess stenosis can cause symptoms of neurogenic claudication, radicular pain, and motor and sensory deficits. If present, back pain is usually attributed to accompanying segmental instability^2,3.

Numerous surgical procedures have been described to date, some of which are still controversial⁴. Over the years, the trend has developed from more aggressive to more selective and minimally invasive techniques. In conve....

Protocol

The study protocol was approved by the institutional review board of the Istanbul Faculty of Medicine.

1. Preoperative procedures

1. Perform the surgeries under general anesthesia. Set the endoscopic and optic instruments, and C-arm devices in the operation room.
2. Ensure that the following tools are available for the procedure: dilator, working sleeve, endoscope with a 20° viewing angle and 177 mm in length with a 9.3 mm diameter oval shaft with a 5.6 mm.......

Discussion

Conventional surgeries for lateral recess stenosis decompression include laminectomy and extensive resection of the soft and bony tissues⁴. Epidural fibrosis and scarring can be problematic, become symptomatic, and make revision surgery more complex⁹. Resection of the posterior musculature and the bony elements can cause surgery-induced segmental instability¹⁰. This has led to the need for more tissue-sparing surgeries. Technical advances have e.......

Materials

Name	Company	Catalog Number	Comments
Burr Oval Ø 5.5 mm	RiwoSpine	899751505	PACK = 1 PC, WL 290 mm, with lateral protection
C-arm	ZIEHM SOLO		C-arm with integrated monitor
Dilator ID 1.1 mm OD 9.4 mm	RiwoSpine	892209510	For single-stage dilatation, TL 235 mm, reusable
Endoscope	RiwoSpine	892103253	20 degrees viewing angle and 177 mm length with a 9.3 mm diameter oval shaft with a 5.6 mm diameter working channel
Kerrison Punch 5.5 mm X 4.5 mm WL 380 mm	RiwoSpine	892409445	60°, TL 460 mm, hinged pushrod, reusable
Punch Ø 3 mm WL 290 mm	RiwoSpine	89240.3023	TL 388 mm, with irrigation connection, reusable
Punch Ø 5.4 mm WL 340 mm	RiwoSpine	892409020	TL 490 mm, with irrigation connection, reusable
Radioablator RF BNDL	RiwoSpine	23300011
RF Instrument BIPO Ø 2.5 mm WL 280 mm	RiwoSpine	4993691	for endoscopic spine surgery, flexible insert, integrated connection cable WL 3 m with device plug to Radioblator RF 4 MHz, sterile, for single use
Rongeur Ø 3 mm WL 290 mm	RiwoSpine	89240.3003	TL 388 mm, with irrigation connection, reusable
Working sleeve ID 9.5 mm OD 10.5 mm	RiwoSpine	8922095000	TL 120, distal end beveled, graduated, reusable