Percutaneous Endoscopic Laminotomy with Flavectomy by Uniportal, Unilateral Approach for the Lumbar Canal or Lateral Recess Stenosis

• Published in: World neurosurgery 2018-05, Vol.113, p.e129-e137
• Main Authors: Lee, Chul-Woo, Yoon, Kang-Jun, Jun, Ji-Ho
• Format: Article
• Language: English
• Subjects: Adult; Aged; Decompression, Surgical - adverse effects; Decompression, Surgical - methods; Disability Evaluation; Dura Mater - diagnostic imaging; Dura Mater - injuries; Female; Follow-Up Studies; Humans; Intervertebral Disc Displacement - surgery; Laminectomy - adverse effects; Laminectomy - methods; Learning Curve; Ligamentum Flavum - diagnostic imaging; Ligamentum Flavum - surgery; Lumbar canal stenosis; Lumbar Vertebrae - diagnostic imaging; Lumbar Vertebrae - surgery; Male; Middle Aged; Minimally invasive; Neuroendoscopy - adverse effects; Neuroendoscopy - methods; Operative Time; Patient Satisfaction; Percutaneous endoscopic; Postoperative Complications - epidemiology; Retrospective Studies; Spinal Stenosis - diagnostic imaging; Spinal Stenosis - surgery; Spondylolisthesis - diagnostic imaging; Spondylolisthesis - surgery; Treatment Outcome; Visual Analog Scale; Zygapophyseal Joint - diagnostic imaging; Zygapophyseal Joint - surgery
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2018.01.195

To evaluate clinical feasibility and safety of percutaneous endoscopic decompression by a uniportal, unilateral approach for lumbar canal or lateral recess stenosis. In this retrospective study, the procedure was performed with endoscopic instruments in the same way as conventional microscopic laminotomy and flavectomy. Clinical outcomes (visual analog scale, Oswestry Disability Index, modified MacNab criteria) were evaluated. Surgical outcomes, including operative time, hospital stay, and complications, were recorded. Decompression was performed in 213 patients (232 lumbar levels) for spinal canal or lateral recess stenosis (unilateral laminotomy, n = 80; bilateral laminotomy, n = 152). Mean follow-up period was 26.45 months. Mean visual analog scale for leg pain, and back pain and mean Oswestry Disability Index improved from 8.24%, 5.35%, and 67.8% at baseline to 1.93% (P < 0.001), 2.05% (P < 0.001), and 17.14% (P < 0.001) at final follow-up. Based on modified MacNab criteria, excellent or good results were obtained in 93.8% of patients. Average operative time was 105.3 ± 56 minutes. In the late period of the learning curve, mean operative time was shortened by two thirds, and mean hospital stay was 2.45 days. There were 12 cases of transient postoperative dysesthesia, 3 cases of motor weakness, and 6 cases of dural tear. No patient had postoperative infection, hematoma, or need for revision surgery for incomplete decompression. Percutaneous endoscopic decompression by a uniportal, unilateral approach is a safe, clinically feasible, and effective surgical technique for treatment of lumbar stenosis. •Percutaneous endoscopic lumbar decompression decompressed neural structures with favorable clinical success.•Surgery-related complications were not worrisome and did not show a high incidence.•Some surgical tips and knowledge helped the surgeon to perform endoscopic decompressive surgery with ease and safety.•Percutaneous endoscopic lumbar decompression is a complex procedure but can be learned with time and surgical experience.