gms | German Medical Science

57th Annual Meeting of the German Society of Neurosurgery
Joint Meeting with the Japanese Neurosurgical Society

German Society of Neurosurgery (DGNC)

11 - 14 May, Essen

Full-endoscopic operation of lumbar degenerative recess stenosis in interlaminar and lateral transforaminal technique

Vollendoskopische Operation der lumbalen degenerativen Rezessusstenose in interlaminärer und lateral transforaminaler Technik

Meeting Abstract

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  • corresponding author S. Rütten - Ressort Wirbelsäulenchirurgie und Schmerztherapie, Zentrum für Orthopädie und Unfallchirurgie, St. Anna-Hospital Herne, am Lehrstuhl für Radiologie und Mikrotherapie, Universität Witten/Herdecke
  • M. Komp - Ressort Wirbelsäulenchirurgie und Schmerztherapie, Zentrum für Orthopädie und Unfallchirurgie, St. Anna-Hospital Herne, am Lehrstuhl für Radiologie und Mikrotherapie, Universität Witten/Herdecke
  • P. Hahn - Ressort Wirbelsäulenchirurgie und Schmerztherapie, Zentrum für Orthopädie und Unfallchirurgie, St. Anna-Hospital Herne, am Lehrstuhl für Radiologie und Mikrotherapie, Universität Witten/Herdecke
  • G. Godolias - Ressort Wirbelsäulenchirurgie und Schmerztherapie, Zentrum für Orthopädie und Unfallchirurgie, St. Anna-Hospital Herne, am Lehrstuhl für Radiologie und Mikrotherapie, Universität Witten/Herdecke

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. Essen, 11.-14.05.2006. Düsseldorf, Köln: German Medical Science; 2006. DocSA.04.04

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2006/06dgnc107.shtml

Published: May 8, 2006

© 2006 Rütten et al.
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Outline

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Objective: According to current knowledge, decompression in lumbar spinal stenosis improves symptoms of neurogenic claudication and neurological deficits. The extent of decompression and additional fusion are still under discussion. The target is sufficient decompression with reduced traumatization and destabilization. The objective of this prospective study was to evaluate the full-endoscopic technique for operation of lumbar degenerative recess stenosis.

Methods: 127 patients were operated lateral transforaminal or interlaminar from 2002 to 2004. Inclusion criteria were: singlelevel recess stenosis, range from discus level to max. mid-pedicle level, no central stenosis, no foramen stenosis of the underlying level, no disk herniation, spondylolisthesis without lysis max. Meyerding Grade I, unilateral leg pain. Conservative therapy time was at least 9 months. The operation was performed full-endoscopically under fluid flow using 7-mm endoscopes with a 4.2-mm intraendoscopic working canal. Follow-up lasted 12 to 30 months. 115 patients (91%) could be followed. In addition to radiological and general criteria, the following measuring instruments were used: VAS, German version NASS Instrument, Oswestry LBPD Questionnaire.

Results: The operation was technically feasible in all cases. There were no intraoperative complications. 3 patients developed transient dysesthesia. The mean operation time was 42 minutes. There was no measurable blood loss. 94 patients (82%) reported no further radicular leg pain, 15 patients (13%) had occasional pain. 6 patients (5%) underwent conventional revision. These reported unsatisfactory results even after revision. The measuring instruments showed a significant, constant improvement. The same was observed in the lengthening of walking distance. No increasing instability was diagnosed radiologically.

Conclusions: Within the indication criteria, the full-endoscopic operation of degenerative recess stenosis is technically feasible. It enables selective procedure with direct visualization. Based on the results, the decompression is found to be sufficient and with few complications, while at the same time enabling reduction of traumatization of the access pathway and spinal canal structures. It offers the advantages of a truly minimally-invasive procedure. The questions of recurrence and stability could not yet be definitively answered.