Comparison of clinical outcomes following minimally invasive or lumbar endoscopic unilateral laminotomy for bilateral decompression

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  • Department of Neurological Surgery, University of Washington, Seattle, Washington
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OBJECTIVE

Minimally invasive lumbar unilateral tubular laminotomy for bilateral decompression has gradually gained acceptance as a less destabilizing but efficacious and safe alternative to traditional open decompression techniques. The authors have further advanced the principles of minimally invasive surgery (MIS) by utilizing working-channel endoscope–based techniques. Full-endoscopic technique allows for high-resolution off-axis visualization of neural structures within the lateral recess, thereby minimizing the need for facet joint resection. The relative efficacy and safety of MIS and full-endoscopic techniques have not been directly compared.

METHODS

A retrospective analysis of 95 consecutive patients undergoing either MIS (n = 45) or endoscopic (n = 50) unilateral laminotomies for bilateral decompression in cases of lumbar spinal stenosis was performed. Patient demographics, operative details, clinical outcomes, and complications were reviewed.

RESULTS

The patient cohort consisted of 41 female and 54 male patients whose average age was 62 years. Half of the patients had single-level, one-third had 2-level, and the remaining patients had 3- or 4-level procedures. The surgical time for endoscopic technique was significantly longer per level compared to MIS (161.8 ± 6.8 minutes vs 99.3 ± 4.6 minutes; p < 0.001). Hospital stay for MIS patients was on average 2.4 ± 0.5 days compared to 0.7 ± 0.1 days for endoscopic patients (p = 0.001). At the 1-year follow-up, endoscopic patients had a significantly lower visual analog scale score for leg pain than MIS patients (1.3 ± 0.3 vs 3.0 ± 0.5; p < 0.01). Moreover, the back pain disability index score was significantly lower in the endoscopic cohort than in the MIS cohort (20.7 ± 3.4 vs 35.9 ± 4.1; p < 0.01). Two patients in the MIS group (epidural hematoma) and one patient in the endoscopic group (disc herniation) required a return to the operating room acutely after surgery (< 14 days).

CONCLUSIONS

Lumbar endoscopic unilateral laminotomy for bilateral decompression is a safe and effective surgical procedure with favorable complication profile and patient outcomes.

ABBREVIATIONS AP = anteroposterior; BMI = body mass index; MCID = minimally clinically important difference; MIS = minimally invasive surgery; ODI = Oswestry Disability Index; SAP = superior articular process; ULBD = unilateral laminotomy for bilateral decompression; VAS = visual analog scale.

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Contributor Notes

Correspondence Christoph Hofstetter: University of Washington, Seattle, WA. chh9045@neurosurgery.washington.edu.

INCLUDE WHEN CITING Published online January 11, 2019; DOI: 10.3171/2018.9.SPINE18689.

Disclosures Dr. Hofstetter reports being a consultant for J&J, Globus, and Joimax.

  • 1

    Alimi M, Hofstetter CP, Pyo SY, Paulo D, Härtl R: Minimally invasive laminectomy for lumbar spinal stenosis in patients with and without preoperative spondylolisthesis: clinical outcome and reoperation rates. J Neurosurg Spine 22:339352, 2015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Alimi M, Hofstetter CP, Torres-Campa JM, Navarro-Ramirez R, Cong GT, Njoku I Jr, : Unilateral tubular approach for bilateral laminotomy: effect on ipsilateral and contralateral buttock and leg pain. Eur Spine J 26:389396, 2017

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Atlas SJ, Keller RB, Robson D, Deyo RA, Singer DE: Surgical and nonsurgical management of lumbar spinal stenosis: four-year outcomes from the maine lumbar spine study. Spine (Phila Pa 1976) 25:556562, 2000

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    Atlas SJ, Keller RB, Wu YA, Deyo RA, Singer DE: Long-term outcomes of surgical and nonsurgical management of lumbar spinal stenosis: 8 to 10 year results from the Maine Lumbar Spine Study. Spine (Phila Pa 1976) 30:936943, 2005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Beurskens AJ, de Vet HC, Köke AJ, van der Heijden GJ, Knipschild PG: Measuring the functional status of patients with low back pain. Assessment of the quality of four disease-specific questionnaires. Spine (Phila Pa 1976) 20:10171028, 1995

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Boukebir MA, Berlin CD, Navarro-Ramirez R, Heiland T, Schöller K, Rawanduzy C, : Ten-step minimally invasive spine lumbar decompression and dural repair through tubular retractors. Oper Neurosurg (Hagerstown) 13:232245, 2017

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Costa F, Sassi M, Cardia A, Ortolina A, De Santis A, Luccarell G, : Degenerative lumbar spinal stenosis: analysis of results in a series of 374 patients treated with unilateral laminotomy for bilateral microdecompression. J Neurosurg Spine 7:579586, 2007

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8

    Dasenbrock HH, Juraschek SP, Schultz LR, Witham TF, Sciubba DM, Wolinsky JP, : The efficacy of minimally invasive discectomy compared with open discectomy: a meta-analysis of prospective randomized controlled trials. J Neurosurg Spine 16:452462, 2012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Deyo RA, Mirza SK, Martin BI: Back pain prevalence and visit rates: estimates from U.S. national surveys, 2002. Spine (Phila Pa 1976) 31:27242727, 2006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Deyo RA, Mirza SK, Martin BI, Kreuter W, Goodman DC, Jarvik JG: Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA 303:12591265, 2010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Evins AI, Banu MA, Njoku I Jr, Elowitz EH, Härtl R, Bernado A, : Endoscopic lumbar foraminotomy. J Clin Neurosci 22:730734, 2015

  • 12

    Fairbank JC, Pynsent PB: The Oswestry Disability Index. Spine (Phila Pa 1976) 25:29402952, 2000

  • 13

    Farrar JT, Portenoy RK, Berlin JA, Kinman JL, Strom BL: Defining the clinically important difference in pain outcome measures. Pain 88:287294, 2000

  • 14

    Farrar JT, Young JP Jr, LaMoreaux L, Werth JL, Poole RM: Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain 94:149158, 2001

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Foley KT, Smith MM, Rampersaud YR: Microendoscopic approach to far-lateral lumbar disc herniation. Neurosurg Focus 7(5):e5, 1999

  • 16

    Fox MW, Onofrio BM, Onofrio BM, Hanssen AD: Clinical outcomes and radiological instability following decompressive lumbar laminectomy for degenerative spinal stenosis: a comparison of patients undergoing concomitant arthrodesis versus decompression alone. J Neurosurg 85:793802, 1996

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Fritzell P, Hägg O, Nordwall A: Complications in lumbar fusion surgery for chronic low back pain: comparison of three surgical techniques used in a prospective randomized study. A report from the Swedish Lumbar Spine Study Group. Eur Spine J 12:178189, 2003

    • Search Google Scholar
    • Export Citation
  • 18

    Ghogawala Z, Dziura J, Butler WE, Dai F, Terrin N, Magge SN, : Laminectomy plus fusion versus laminectomy alone for lumbar spondylolisthesis. N Engl J Med 374:14241434, 2016

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Guha D, Heary RF, Shamji MF: Iatrogenic spondylolisthesis following laminectomy for degenerative lumbar stenosis: systematic review and current concepts. Neurosurg Focus 39(4):E9, 2015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Hägg O, Fritzell P, Ekselius L, Nordwall A: Predictors of outcome in fusion surgery for chronic low back pain. A report from the Swedish Lumbar Spine Study. Eur Spine J 12:2233, 2003

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Hasegawa K, Kitahara K, Shimoda H, Hara T: Facet joint opening in lumbar degenerative diseases indicating segmental instability. J Neurosurg Spine 12:687693, 2010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    Jarvik JJ, Hollingworth W, Heagerty P, Haynor DR, Deyo RA: The Longitudinal Assessment of Imaging and Disability of the Back (LAIDBack) Study: baseline data. Spine (Phila Pa 1976) 26:11581166, 2001

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Jönsson B, Annertz M, Sjöberg C, Strömqvist B: A prospective and consecutive study of surgically treated lumbar spinal stenosis. Part II: Five-year follow-up by an independent observer. Spine (Phila Pa 1976) 22:29382944, 1997

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Komp M, Hahn P, Oezdemir S, Giannakopoulos A, Heikenfeld R, Kasch R, : Bilateral spinal decompression of lumbar central stenosis with the full-endoscopic interlaminar versus microsurgical laminotomy technique: a prospective, randomized, controlled study. Pain Physician 18:6170, 2015

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    Kreiner DS, Shaffer WO, Baisden JL, Gilbert TJ, Summers JT, Toton JF, : An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis (update). Spine J 13:734743, 2013

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    Leone A, Guglielmi G, Cassar-Pullicino VN, Bonomo L: Lumbar intervertebral instability: a review. Radiology 245:6277, 2007

  • 27

    Machado GC, Ferreira PH, Yoo RI, Harris IA, Pinheiro MB, Koes BW, : Surgical options for lumbar spinal stenosis. Cochrane Database Syst Rev 11:CD012421, 2016

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28

    Malmivaara A, Slätis P, Heliövaara M, Sainio P, Kinnunen H, Kankare J, : Surgical or nonoperative treatment for lumbar spinal stenosis? A randomized controlled trial. Spine (Phila Pa 1976) 32:18, 2007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29

    Overdevest G, Vleggeert-Lankamp C, Jacobs W, Thomé C, Gunzburg R, Peul W: Effectiveness of posterior decompression techniques compared with conventional laminectomy for lumbar stenosis. Eur Spine J 24:22442263, 2015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30

    Panjabi MM: Clinical spinal instability and low back pain. J Electromyogr Kinesiol 13:371379, 2003

  • 31

    Parker SL, Fulchiero EC, Davis BJ, Adogwa O, Aaronson OS, Cheng JS, : Cost-effectiveness of multilevel hemilaminectomy for lumbar stenosis-associated radiculopathy. Spine J 11:705711, 2011

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32

    Parker SL, Godil SS, Mendenhall SK, Zuckerman SL, Shau DN, McGirt MJ: Two-year comprehensive medical management of degenerative lumbar spine disease (lumbar spondylolisthesis, stenosis, or disc herniation): a value analysis of cost, pain, disability, and quality of life: clinical article. J Neurosurg Spine 21:143149, 2014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33

    Perez-Cruet MJ, Foley KT, Isaacs RE, Rice-Wyllie L, Wellington R, Smith MM, : Microendoscopic lumbar discectomy: technical note. Neurosurgery 51 (5 Suppl):S129S136, 2002

    • Search Google Scholar
    • Export Citation
  • 34

    Ruetten S, Komp M, Merk H, Godolias G: Surgical treatment for lumbar lateral recess stenosis with the full-endoscopic interlaminar approach versus conventional microsurgical technique: a prospective, randomized, controlled study. J Neurosurg Spine 10:476485, 2009

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35

    Suri P, Boyko EJ, Goldberg J, Forsberg CW, Jarvik JG: Longitudinal associations between incident lumbar spine MRI findings and chronic low back pain or radicular symptoms: retrospective analysis of data from the longitudinal assessment of imaging and disability of the back (LAIDBACK). BMC Musculoskelet Disord 15:152, 2014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36

    Taylor WR, Chen JW, Meltzer H, Gennarelli TA, Kelbch C, Knowlton S, : Quantitative pupillometry, a new technology: normative data and preliminary observations in patients with acute head injury. Technical note. J Neurosurg 98:205213, 2003

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37

    Thomé C, Zevgaridis D, Leheta O, Bäzner H, Pöckler-Schöniger C, Wöhrle J, : Outcome after less-invasive decompression of lumbar spinal stenosis: a randomized comparison of unilateral laminotomy, bilateral laminotomy, and laminectomy. J Neurosurg Spine 3:129141, 2005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38

    Wagner SC, Butler JS, Kaye ID, Sebastian AS, Morrissey PB, Kepler CK: Risk factors for and complications after surgical delay in elective single-level lumbar fusion. Spine (Phila Pa 1976) 43:228233, 2018

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39

    Weinstein JN, Tosteson TD, Lurie JD, Tosteson AN, Blood E, Hanscom B, : Surgical versus nonsurgical therapy for lumbar spinal stenosis. N Engl J Med 358:794810, 2008

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40

    Wilby MJ, Seeley H, Laing RJ: Laminectomy for lumbar canal stenosis: a safe and effective treatment. Br J Neurosurg 20:391395, 2006

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