Article
Full-endoscopic transforaminal and interlaminar operation of degenerative lateral spinal stenosis using new endoscopes and instruments
Vollendoskopische transforaminale und interlaminäre Operation der degenerativen lateralen Spinalkanalstenose mittels neuer Endoskope und Instrumente
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Authors
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S. Rütten
- Department Spine Surgery and Pain Therapy, Clinic for Orthopaedics, Department for Radiology and Microtherapy, University of Witten/Herdecke, St. Anna-Hospital Herne
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M. Komp
- Department Spine Surgery and Pain Therapy, Clinic for Orthopaedics, Department for Radiology and Microtherapy, University of Witten/Herdecke, St. Anna-Hospital Herne
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G. Godolias
- Department Spine Surgery and Pain Therapy, Clinic for Orthopaedics, Department for Radiology and Microtherapy, University of Witten/Herdecke, St. Anna-Hospital Herne
| Published: | May 4, 2005 |
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Outline
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Objective
Surgical therapy of lumbar spinal canal stenosis aims at sufficient decompression with reduction of operation-induced traumatization and destabilization. The influence of the extent of decompression or concurrent fusion is a matter of discussion. The objective of this prospective study was to assess a full-endoscopic selective technique for surgery of degenerative lateral spinal canal stenosis without instability using new endoscopes and instruments.
Methods
61 patients were operated in 2003. The mean age was 53 years. Clinical inclusion criteria were: radicular one-sided ischialgias, neurogenic claudication, complaint time max. 18 months. Imaging inclusion criteria were: monosegmental lateral recessus stenosis, no foramen stenosis of the underlying segments, spondylolisthesis max. Meyerding Grade I, scoliosis less than 20°. The operation was performed full-endoscopically under fluid flow with new 7-mm endoscopes with 4-mm intraendoscopic work channel and new instruments. Specific anatomical criteria for using the interlaminar or lateral transforaminal approach were given. The follow-up time lasted from 12 to 19 months. 57 patients (93%) were included in the follow-up.
Results
The planned operation was technically feasible in all cases. No serious complications occurred. 2 patients presented with transient dysesthesia. The mean operation time was 43 minutes. There was no measurable blood loss. The max. hospital stay was 4 days. The measurement instruments revealed significant improvement. 47 patients (82%) reported no further radicular leg pain, 7 patients (13%) reported occasional pain. 3 patients (5%) experienced no improvement and underwent conventional revision. No increasing instability could be determined radiologically. All results remained constant.
Conclusions
Within the prescribed narrow indication criteria, the method described is technically possible. It enables a more selective procedure with visualization of the recessus without extensive resection of bone structures. Based on early results, decompression is found to be sufficient and free of complications, while offering the advantages of a truly minimal-invasive procedure. Further studies will be conducted to answer the question of recurrence and stability.
