Technical ReportIrrigation endoscopic decompressive laminotomy. A new endoscopic approach for spinal stenosis decompression
Introduction
Spinal canal stenosis is the most common indication for lumbar spine surgery in adults older than 65 years [1]. The traditional surgical treatment involves bilateral dissection of paraspinal muscles to expose all the involved levels, removal of the supraspinous and interspinous ligaments, wide laminectomy, and medial facetectomy with foraminotomy [2]. Frequent failures have been attributed to paraspinal muscle atrophy and denervation resulting in potential chronic pain [3], [4] and to the increased incidence of postoperative spinal instability [4], [5], [6], [7], [8], [9].
To overcome these problems and reduce the time for hospitalization and postoperative recovery, several less invasive techniques have been introduced including multiple laminotomies, chimney sublaminar decompression [10], [11], [12], and the “ over the top technique,” which describes bilateral spinal decompression using an ipsilateral hemilaminotomy and contralateral decompression beneath the midline structures [13], [14]. This technique was later modified by the introduction of the endoscope through a tubular retractor and named microendoscopic decompressive laminotomy [15], [16], [17].
In the current clinical series, a new minimally invasive procedure for spinal canal decompression named the irrigation endoscopic decompressive laminotomy (IEDL) is presented. The latter is based on the irrigation endoscopic discectomy technique [18] where the endoscope and instruments were directly placed over the surface of the lamina through 0.5-cm skin portals without any muscle stripping or dilatation. This is followed by spinal canal decompression using “over the top technique” under continuous endoscopic vision.
The purposes of the present study were to evaluate the results of decompression using the IEDL technique and assess its effect on the postoperative course.
Section snippets
Materials and methods
The study was conducted after the approval of the institutional review board. All patients signed a consent that they will be enrolled in clinical study involving a new endoscopic technique for spinal canal decompression.
Primary outcome measures were assessed using the Oswestry Disability Index (ODI) [19] and the modified Macnab criteria [20]. In addition, the operative time and complication rate were evaluated. Secondary outcome measures included the extent of surgical invasion, which has been
Results
From September 2009 to December 2011, a total of 104 consecutive patients were operated in our institution. Baseline patient demographics and disease characteristics are summarized in (Table 3).
The mean follow-up period was 28 months. Ten cases were lost at the time of final follow-up, two died of irrelevant disease, and eight did not respond to our attempts of contact by phone or mail, giving a 90% of follow-up data available.
The mean operative time was 62.8 min/level, and the estimated blood
Discussion
Traditional treatment of spinal stenosis involved bilateral retraction of the paraspinal muscles, wide laminectomy, medial facetectomy and foraminotomy. Frequent surgical failures have been attributed to local tissue trauma [3], [4], postoperative spinal instability [4], [5], [7], [9], which has led to marked increase in lumbar fusion surgery [23].
On the other hand, the target of minimally invasive spine surgery has always been to reduce approach-related morbidity, aiming the improvement of the
Conclusions
From our initial experience, we conclude that the IEDL enables the surgeon to perform complete decompression of the neurologic structures under excellent illumination and magnification. Success rates similar to open decompression have been achieved. Meanwhile, significant reduction of the surgical morbidity has been observed. This would be of special value in cases of spinal stenosis where patients are usually of an elderly age group with associated medical comorbidities and a disease usually
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FDA device/drug status: Not applicable.
Author disclosures: HMS: Nothing to disclose.
The study has been conducted after approval of the institutional review board: CUK-O221209.
There was no source of external funding for this study.