Article
Navigation guided endoscopic decompression of lumar spinal stenosis via translaminar approach. Introduction of the Spondyloscop
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Authors
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Witold Polanski
- Universitätsklinik Dresden, Carl-Gustav-Carus Universitätsklinikum an der Technischen Universität Dresden, Dresden, Deutschland
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Hongzhen Jiang
- Dresden, Deutschland
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Marek Molcanyi
- Köln, Deutschland
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Jozef Zivcak
- Kosice, Slovakia
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Daniel Ruess
- Köln, Deutschland
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Clemens Reinshagen
- Boston, United States
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Gabriele Schackert
- Klinikum Carl Gustav Carus, Klinik und Poliklinik für Neurochirurgie, Carl-Gustav-Carus Universitätsklinikum an der Technischen Universität Dresden, Dresden, Deutschland
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Bernhard Rieger
- Universitätsklinikum Carl Gustav Carus der TU Dresden, Klinik und Poliklinik für Neurochirurgie, Dresden, Deutschland
| Published: | June 9, 2017 |
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Outline
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Objective: To preserve integrity of facet joints, we have changed the routine of microscopic decompression. Starting at the basis of the spinous process, the bone is removed with a high speed drill and the interlaminar route can be replaced by the translaminar access. After elimination of the central stenosis, both topassing nerve roots are able to be decompressed and the hidden zones can be reached for the upper nerve roots. This strategy could be transferred into endoscopy. Until now, endoscopy permits only the interlaminar and the transforaminal access and the technical requirements are still missing for the translaminar approach. As more bone must be removed for the translaminar approach, our task was to create a downwardly conically opening, fully-turned tube, in which a high speed drill and an endoscope can be placed simultaneously.
Methods: Firstly we report translaminar access via a navigated guided tube together with a high speed drill, afterwards to perform decompression with a conventional endoscope in 27 patients with central lumbar stenosis and radicular pain due to additional recess stenosis caused by facet joint hypertrophy. Performing the translaminar approach with the navigation guided high speed drill endoscopic decompression could be completed in an appropriate surgical time. Patient and surgical data, numeric rating scale (NRS) for back and leg pain, core outcome measures index (COMI) and Oswestry disability index (ODI) were recorded preoperatively and three months after surgery.
Results: Average age was 69.3years. No conversion to open surgery was necessary. 17 patients suffered from two levels spinal stenosis. In these patients both levels were successfully decompressed via one single endoscopic port. The mean operative time including the time necessary to perform the 3D-scan was about 132min while the mean surgical time (without scan) per level was 63min. There was no measurable intra- or postoperative blood loss due to continuous saline lavage and missing need for drainage. The mean hospital stay was 6.2days. No nerve root injury, infection or cerebrospinal fluid fistula occurred. Comparison between preoperative and 3-months follow-up showed improvement of clinical scores: ODI improved from 48.3 to 17.5; NRS-back improved from 7.3 to 1.5; NRS-leg improved from 8.2 to 2.5; COMI decreased from 9.6 to 2.9.
Conclusion: This successful proof of principle for navigation guided endoscopic assisted decompression of lumbar stenosis via translaminar access made us to advance this technique developing the Spondyloskop® for simultaneous high speed drilling under full endoscopic control. Spinal stenosis can be effectively treated via the translaminar approach. Without difficulty it is possible to reach up to two levels using the same endoscopic skin incision. Additionally the use of navigation contributes a steeper surgeon’s learning curve.
