Surgical treatment for lumbar lateral recess stenosis with the full-endoscopic interlaminar approach versus conventional microsurgical technique: a prospective, randomized, controlled study

Clinical article

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Object

Extensive decompression with laminectomy where appropriate is often still described as the method of choice in surgery for lateral recess stenosis. Nonetheless, tissue-sparing procedures are becoming more common. Endoscopic techniques have become the standard in many areas because of the advantages they offer in surgical technique and in rehabilitation. Transforaminal and interlaminar access provide 2 full-endoscopic (FE) techniques for lumbar spine surgery. The goal of this prospective randomized controlled study was to compare the surgical results for the FE technique via the interlaminar approach with those of the conventional microsurgical technique in patients with degenerative lateral recess stenosis.

Methods

A total of 161 patients with FE or microsurgical decompression underwent follow-up for 2 years. In addition to general and specific parameters, the following measuring instruments were used: visual analog scale, German version of the North American Spine Society instrument, and the Oswestry low-back pain disability questionnaire.

Results

The results show that 74.5% of patients reported no longer having leg pain, and 20.5% had only occasional pain. The clinical results were the same in both groups. The rate of complications and revisions was significantly reduced in the FE group. The FE techniques brought advantages in the following areas: operation, complications, traumatization, and rehabilitation.

Conclusions

The clinical results of the FE interlaminar technique are equal to those of the microsurgical technique. At the same time, there are advantages in the operation technique, such as reduced traumatization. The FE interlaminar spinal decompression procedure is a sufficient and safe supplement and alternative to microsurgical procedures.

Abbreviations used in this paper: FE = full-endoscopic; MI = microsurgical intervention; NASS = North American Spine Society; ODI = Oswestry Disability Index; VAS = visual analog scale.

Article Information

Address correspondence to: Sebastian Ruetten, M.D., Department of Spine Surgery and Pain Therapy, Center for Orthopaedics and Traumatology, St. Anna-Hospital Herne, Hospitalstrasse 19, 44649 Herne, Germany. email: info@s-ruetten.com.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Intraoperative photograph showing the interlaminar approach for the FE operation.

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    Drawing showing how bone decompression is accomplished using a 4-mm bur.

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    Bar graphs showing the mean VAS leg and back and ODI scores in the MI group (upper) and in the FE group (lower). Numbers on the y axes designate the VAS and ODI scores in both panels, and the numbers above individual bars denote the number of patients in each category.

  • View in gallery

    Bar graphs showing the mean values of NASS pain and neurology categories in the MI group (upper) and in the FE group (lower). The commas represent decimals.

  • View in gallery

    Bar graph showing clinical results in the MI and FE groups. Numbers on the y axis denote percentages. The commas represent decimals.

  • View in gallery

    Bar graph showing pre- and postoperative leg and back pain in the MI and FE groups. Numbers above individual bars designate the number of patients in each category, and numbers on the y axis denote the VAS scores.

  • View in gallery

    Left: Preoperative CT scan obtained in a patient with degenerative lateral recess stenosis. Right: Postoperative CT scan obtained after FE interlaminar decompression.

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