Endoscope-assisted spinal decompression surgery for lumbar spinal stenosis

Technical note

Akihito Minamide M.D., Ph.D., Munehito Yoshida M.D., Ph.D., Hiroshi Yamada M.D., Ph.D., Yukihiro Nakagawa M.D., Ph.D., Masaki Kawai M.D., Kazuhiro Maio M.D., Ph.D., Hiroshi Hashizume M.D., Ph.D., Hiroshi Iwasaki M.D., Ph.D., and Shunji Tsutsui M.D., Ph.D.
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  • Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
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Object

The authors undertook this study to document the clinical outcomes of microendoscopic laminotomy, a minimally invasive decompressive surgical technique using spinal endoscopy for lumbar decompression, in patients with lumbar spinal stenosis (LSS).

Methods

A total of 366 patients were enrolled in the study and underwent microendoscopic laminotomy between 2007 and 2010. Indications for surgery were single- or double-level LSS, persistent neurological symptoms, and failure of conservative treatment. Microendoscopy provided wide visualization through oblique lenses and allowed bilateral decompression via a unilateral approach, through partial resection of the base of the spinous process, thereby preserving the supraspinous and interspinous ligaments and contralateral musculature. Clinical symptoms and signs of low-back pain were evaluated prior to and following surgical intervention by applying the Japanese Orthopaedic Association (JOA) scoring system, Roland-Morris Disability Questionnaire (RMDQ), Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), and 36-Item Short Form Health Survey (SF-36). These items were evaluated preoperatively and 2 years postoperatively.

Results

Effective circumferential decompression was achieved in all patients. The 2-year follow-up evaluation was completed for 310 patients (148 men and 162 women; mean age 68.7 years). The average recovery rate based on the JOA score was 61.3%. The overall results were excellent in 34.9% of the patients, good in 34.9%, fair in 21.7%, and poor in 8.5%. The mean RMDQ score significantly improved from 11.3 to 4.8 (p < 0.001). In all categories of both JOABPEQ and SF-36, scores at 2 years' follow-up were significantly higher than those obtained before surgery (p < 0.001). Twelve surgery-related complications were identified: dural tear (6 cases [1.9%]), wrong-level operation (1 [0.3%]), transient neuralgia (4 [1.3%]), and infection (1 [0.3%]). All patients recovered, and there were no serious postoperative complications.

Conclusions

Microendoscopic laminotomy is a safe and very effective minimally invasive surgical technique for the treatment of degenerative LSS.

Abbreviations used in this paper:JOA = Japanese Orthopaedic Association; JOABPEQ = JOA Back Pain Evaluation Questionnaire; LSS = lumbar spinal stenosis; RMDQ = Roland-Morris Disability Questionnaire; SF-36 = 36-Item Short Form Health Survey; TLIF = transforaminal lumbar interbody fusion.

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Contributor Notes

Address correspondence to: Akihito Minamide, M.D., Ph.D., Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-8510, Japan. email: minamide@wakayama-med.ac.jp.

Please include this information when citing this paper: published online October 4, 2013; DOI: 10.3171/2013.8.SPINE13125.

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