Article
Endoscopic surgery of monosegmental unilateral lumbar recess stenosis – Is decompression and partial discectomy advantageous over decompression alone? A report of 66 consecutive patients
Die endoskopische Dekompression bei unilateraler monosegmentaler Rezessus laterialis Stenose – Ist die Dekompression und partielle Diskektomie der alleiniger Dekompression überlegen? Ein Bericht einer konsekutiven Serie von 66 Patienten
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Authors
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Benedikt Burkhardt
- Universität des Saarlandes, Klinik für Neurochirurgie, Homburg, Deutschland
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Joachim Oertel
- Universität des Saarlandes, Klinik für Neurochirurgie, Homburg, Deutschland
| Published: | June 26, 2020 |
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Outline
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Objective: Lumbar lateral recess stenosis (LRS) typically results in radiculopathy. Yet, it remains uncertain if there is a difference in clinical outcome for decompression alone (DA) and decompression with partial discectomy (DPD) in endoscopic procedures.
Methods: Sixty-six consecutive patients who underwent endoscopic decompression for LRS were identified from a prospectively collected database. Preoperative MRI and endoscopic video were analysed with special focus on the technique of nerve roof decompression. DPD was performed once DA and dissection of adhesive epidural tissue was not sufficient to completely mobilize the dura and the exiting nerve root. Clinical outcome was assessed via a personal examination, a standardized questionnaire including the Oswestry Disability Index (ODI), and the modified MacNab criteria to assess clinical success.
Results: DA was performed in 19 (28.8%) patients and DPD in 47 patients (71.2%). The mean follow-up was 44.0 months (range: 3-82 months) at which 60 patients attended (90.1%). Fifty-six patients reported to be free of leg pain (93.3%), full muscle strength was found in 52 patients (86.7%), and in fifty patients no sensory disturbance was noted (83.3%). The mean ODI was 16% (range: 0%-60%). Clinical success was noted in 52 patients (86.6%). Clinical success rate was significantly higher in patients treated with DPD compared to DA (p= 0.04). The reoperation rate at the index segment was 10.0%. There were no differences between DA and DPD with respect to ODI and the rate of reoperation (p=0.686, p=0.897).
Conclusion: Endoscopic DA and DPD of LRS offers a high rate of clinical success and relief of radicular pain. DPD had a significantly higher success rate compared to DA. Repeated procedure at the index segment was performed in 10.0%. There was no significant difference for the rate of reoperation and ODI for both techniques.
