J Neurol Surg A Cent Eur Neurosurg 2019; 80(04): 302-311
DOI: 10.1055/s-0038-1677052
Technical Note
Georg Thieme Verlag KG Stuttgart · New York

Percutaneous Endoscopic Lumbar Foraminoplasty for Lumbar Foraminal Stenosis of Elderly Patients with Unilateral Radiculopathy: Radiographic Changes in Magnetic Resonance Images

Jongchul Chung
1   Department of Neurosurgery, Busan Bumin Hospital, Busan, Republic of Korea
,
Changbong Kong
2   Department of Neurosurgery, Pohang Stroke and Spine Hospital, Pohang, Republic of Korea
,
Woosung Sun
1   Department of Neurosurgery, Busan Bumin Hospital, Busan, Republic of Korea
,
Dohyung Kim
3   Department of Neurosurgery, Ohsung Hospital, Busan, Republic of Korea
,
Hyungdong Kim
1   Department of Neurosurgery, Busan Bumin Hospital, Busan, Republic of Korea
,
Heungtae Jeong
4   Department of Orthopedic Surgery, Busan Bumin Hospital, Busan, Republic of Korea
› Author Affiliations
Further Information

Publication History

21 February 2018

25 May 2018

Publication Date:
18 March 2019 (online)

Abstract

Background and Study Aims/Objective Clinical outcomes of percutaneous endoscopic lumbar foraminoplasty (PELF) performed for lumbar foraminal stenosis (LFS) have been reported in the literature. However, no study has reported the radiographic changes in magnetic resonance imaging (MRI) after surgery. This report presents the clinical outcome as well as radiographic changes in MRI after PELF for elderly patients with unilateral radiculopathy. We also describe detailed operative nuances to expand the foraminal space and mobilize the affected nerve root.

Material and Methods Between January 2015 and December 2016, 24 patients over 65 years of age underwent PELF to treat unilateral radiculopathy caused by LFS. The demographics, medical history, visual analog scale (VAS), and Oswestry Disability Index (ODI) were reviewed retrospectively. MRI radiographic data, cross-sectional area (CSA) of the affected foramen and nerve root, were evaluated before and after surgery.

Results Preoperative radiculopathy improved in 23 of 24 patients (96%). The VAS score significantly improved from 7.89 ± 1.8 to 2.57 ± 2.5 (67.4%). The ODI also significantly improved from 33.15 ± 9.2 to 10.24 ± 6.7 (69.1%). Foraminal width increased ∼ 1.67 mm (21.4%), foraminal height increased 5.00 mm (36.9%), and CSA increased about 55.27 mm2 (60.6%) (p < 0.001). The CSA and the shape of the affected nerve section also expanded, but these were not statistically significant.

Conclusion We performed PELF in elderly patients with LFS. There were considerable radiographic changes in MRI, and the patients also showed clinically relevant improvement. Thus PELF resulted in sufficient decompression of the nerve root in LFS.

 
  • References

  • 1 Fujibayashi S, Neo M, Takemoto M, Ota M, Nakamura T. Paraspinal-approach transforaminal lumbar interbody fusion for the treatment of lumbar foraminal stenosis. J Neurosurg Spine 2010; 13 (04) 500-508
  • 2 Hejazi N, Witzmann A, Hergan K, Hassler W. Combined transarticular lateral and medial approach with partial facetectomy for lumbar foraminal stenosis. Technical note. J Neurosurg 2002; 96 (1, Suppl): 118-121
  • 3 Marquardt G, Bruder M, Theuss S, Setzer M, Seifert V. Ultra-long-term outcome of surgically treated far-lateral, extraforaminal lumbar disc herniations: a single-center series. Eur Spine J 2012; 21 (04) 660-665
  • 4 Ozeki N, Aota Y, Uesugi M. , et al. Clinical results of intrapedicular partial pediculectomy for lumbar foraminal stenosis. J Spinal Disord Tech 2008; 21 (05) 324-327
  • 5 Yamada K, Matsuda H, Cho H, Habunaga H, Kono H, Nakamura H. Clinical and radiological outcomes of microscopic partial pediculectomy for degenerative lumbar foraminal stenosis. Spine 2013; 38 (12) E723-E731
  • 6 Yamada K, Matsuda H, Nabeta M, Habunaga H, Suzuki A, Nakamura H. Clinical outcomes of microscopic decompression for degenerative lumbar foraminal stenosis: a comparison between patients with and without degenerative lumbar scoliosis. Eur Spine J 2011; 20 (06) 947-953
  • 7 Ahn Y, Jang IT, Kim WK. Transforaminal percutaneous endoscopic lumbar discectomy for very high-grade migrated disc herniation. Clin Neurol Neurosurg 2016; 147: 11-17
  • 8 Ahn Y, Lee SH, Park WM, Lee HY. Posterolateral percutaneous endoscopic lumbar foraminotomy for L5-S1 foraminal or lateral exit zone stenosis. Technical note. J Neurosurg 2003; 99 (3, Suppl): 320-323
  • 9 Osman SG, Nibu K, Panjabi MM, Marsolais EB, Chaudhary R. Transforaminal and posterior decompressions of the lumbar spine. A comparative study of stability and intervertebral foramen area. Spine 1997; 22 (15) 1690-1695
  • 10 Knight MT, Goswami A, Patko JT, Buxton N. Endoscopic foraminoplasty: a prospective study on 250 consecutive patients with independent evaluation. J Clin Laser Med Surg 2001; 19 (02) 73-81
  • 11 Yeung AT, Tsou PM. Posterolateral endoscopic excision for lumbar disc herniation: surgical technique, outcome, and complications in 307 consecutive cases. Spine 2002; 27 (07) 722-731
  • 12 Choi G, Lee SH, Lokhande P. , et al. Percutaneous endoscopic approach for highly migrated intracanal disc herniations by foraminoplastic technique using rigid working channel endoscope. Spine 2008; 33 (15) E508-E515
  • 13 Henmi T, Terai T, Hibino N. , et al. Percutaneous endoscopic lumbar discectomy utilizing ventral epiduroscopic observation technique and foraminoplasty for transligamentous extruded nucleus pulposus: technical note. J Neurosurg Spine 2015; October 13 (Epub ahead of print)
  • 14 Knight MT, Ellison DR, Goswami A, Hillier VF. Review of safety in endoscopic laser foraminoplasty for the management of back pain. J Clin Laser Med Surg 2001; 19 (03) 147-157
  • 15 Knight M, Goswami A. Management of isthmic spondylolisthesis with posterolateral endoscopic foraminal decompression. Spine 2003; 28 (06) 573-581
  • 16 Chang SB, Lee SH, Ahn Y, Kim JM. Risk factor for unsatisfactory outcome after lumbar foraminal and far lateral microdecompression. Spine 2006; 31 (10) 1163-1167
  • 17 Hafez MI, Zhou S, Coombs RR, McCarthy ID. The effect of irrigation on peak temperatures in nerve root, dura, and intervertebral disc during laser-assisted foraminoplasty. Lasers Surg Med 2001; 29 (01) 33-37