Dataset Information

Treatment of Soft Tissue and Bony Spinal Stenosis by a Visualized Endoscopic Transforaminal Technique Under Local Anesthesia.

ABSTRACT:

Objective

To analyze long-term clinical outcomes of endoscopic transforaminal foraminoplasty for foraminal stenosis.

Methods

Long-term 5-year MacNab outcomes, visual analogue scale (VAS) scores, complications, and unintended aftercare were analyzed in a series of 86 patients who underwent endoscopic transforaminal foraminoplasty for foraminal stenosis.

Results

At minimum 5-year follow-up, excellent results according to the MacNab criteria were obtained in 32 patients (37.2%), Good in 40 (46.5%), fair in 11 (12.8%), and poor in 3 (3.5%), respectively. The mean preoperative VAS was 6.15. The mean postoperative and last follow-up VAS was 3.44. Both postoperative VAS and last follow-up VAS were statistically reduced at a significance level of p<0.0001. Postoperative dysesthesia occurred in 9 patients. Another 9 patients had recurrent disc herniations (10.5%). Failure to cure with persistent pain occurred in 3 patients. Two patients developed pain postoperatively stemming from a different level. One patient experienced a postoperative hematoma which ultimately was inconsequential and did not require any additional surgery. Only 3 patients opted for revision endoscopic discectomy and another 2 for revision fusion surgery.

Conclusion

Patients with symptomatic foraminal stenosis may be treated successfully with early transforaminal endoscopic decompression while maintaining favorable long-term outcomes without the need for fusion in the vast majority of patients.

SUBMITTER: Yeung A

PROVIDER: S-EPMC6449822 | biostudies-literature | 2019 Mar

REPOSITORIES: biostudies-literature

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Publications

Treatment of Soft Tissue and Bony Spinal Stenosis by a Visualized Endoscopic Transforaminal Technique Under Local Anesthesia.

Yeung Anthony A Roberts Andrew A Zhu Lifan L Qi Lei L Zhang Jun J Lewandrowski Kai-Uwe KU

Neurospine 20190331 1

<h4>Objective</h4>To analyze long-term clinical outcomes of endoscopic transforaminal foraminoplasty for foraminal stenosis.<h4>Methods</h4>Long-term 5-year MacNab outcomes, visual analogue scale (VAS) scores, complications, and unintended aftercare were analyzed in a series of 86 patients who underwent endoscopic transforaminal foraminoplasty for foraminal stenosis.<h4>Results</h4>At minimum 5-year follow-up, excellent results according to the MacNab criteria were obtained in 32 patients (37.2% ...[more]

PMID: 30943707

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Project description:BACKGROUND:One advantage of an endoscopic approach to treating lumbar spinal stenosis is preservation of spine stability and the adjacent anatomy, and there is a decrease in adjacent segment disc degeneration. The purpose of this study was to discuss the clinical efficacy of percutaneous transforaminal endoscopic decompression for the treatment of lumbar spinal stenosis (LSS). METHODS:This is a retrospective study. From September 2012 to June 2017, 45 patients who were diagnosed with LSS underwent the treatment of percutaneous transforaminal endoscopic decompression (PTED) and were followed up at 1 week, 3 months and 1 year postoperatively. Low back pain and leg pain were measured by Visual Analogue Scale scoring methods (VAS-back and VAS-leg), while functional outcomes were assessed by using the Oswestry Disability Index (ODI). All patients had one-level lumbar spinal stenosis. RESULTS:The most common type of stenosis was lateral recess stenosis (n?=?22; 48.9%), followed by central stenosis (n?=?13; 28.9%) and foraminal stenosis (n?=?10: 22.2%). Regarding comparisons of VAS-back, VAS-leg, and ODI scores before and after operation, VAS and ODI scores significantly improved. The average leg VAS score improved from 7.01?±?0.84 to 2.28?±?1.43 (P?<?0.001). The average ODI improved from 46.18?±?10.11 to 14.40?±?9.59 (P?<?0.001). We also examined changes in ODI and VAS scores from baseline according to types of spinal stenosis, stenosis grade, spinal instability, and revision surgery in the same segment. The improvement percentage of leg VAS score was significantly less in patients with severe stenosis at both 3 months and 1 year postoperatively. The improvement percentages of ODI and leg VAS scores were significantly less in patients who had spinal instability and patients who had undergone revision surgery. CONCLUSION:The PTED approach seems to give good results for the treatment of LSS. However, this approach may be less effective for LSS patients who have lumbar instability or require revision surgery in the same segment.

Project description:Background:The indications of different endoscopic and endoscopically assisted translaminar approaches for lumbar spinal stenosis are not well-defined, and validated protocols for the use of the transforaminal over the interlaminar approach are lacking. Methods:We performed a retrospective study employing an image-based patient stratification protocol of stenosis location (type I-central canal, type II-lateral recess, type III-foraminal, type IV-extraforaminal) and clinical outcomes on 249 patients consisting of 137 (55%) men and 112 (45%) women with an average age of 56.03±16.8 years who underwent endoscopic surgery for symptomatic spinal stenosis from January 2013 to February 2019. The average follow-up of 38.27±27.9 months. The primary clinical outcome measures were the Oswestry Disability Index (ODI), Visual Analogue Scale (VAS), and modified Macnab criteria. Results:The frequency of stenosis configuration in decreasing order was as follows: type I-121/249; 48.6%, type III-104/249; 41.8%, type II-15/249; 6%, and type IV-9/249; 3.6%. The transforaminal approach (137/249; 55.0%) was used in most type II to IV lesions followed by the interlaminar approach (78/249; 31.3%), and the full endoscopic approach (12/249; 4.8%), and the endoscopically assisted translaminar approach (8/249; 3.2%) which was exclusively used for type I lesions. Macnab outcomes analysis showed Excellent in 47 patients (18.9%), Good in 178 (71.5%), Fair in 18 (7.2%) and Poor in 6 (2.4%), respectively. Paired two-tailed t-test showed statistically significant VAS (5.46±2.1; P<0.0001) and ODI (37.1±16.9; P<0.0001) reductions as a result of the endoscopic decompression surgery. Cross-tabulation of the Macnab outcomes versus the endoscopic approach and surgical technique confirmed beneficial association of the approach selection with Excellent (P=0.001) and Good (P<0.0001) outcomes with statistically significance. Conclusions:This study suggests that in the hands of skilled endoscopic spines surgeon use of an image-based stenosis location protocol may contribute to obtaining Excellent and Good clinical outcomes in a high percentage (93%) of patients suffering from lumbar stenosis related radiculopathy. Additional comparative studies should examine the prognostic value of choosing the endoscopic approach on the basis of the proposed four-type stenosis protocol by correlating its impact on outcomes with preoperative diagnostic injections and intraoperative direct visualization of symptomatic pain generators under local anesthesia and sedation.

Project description:BACKGROUND:The objective of this study was to evaluate the clinical effect and correlation between preoperative imaging parameters and the clinical effect of endoscopic transforaminal decompression for lumbar spinal stenosis. METHODS:In this prospective study, 87 patients from Shanxi Province People's Hospital met the criteria for lumbar spinal stenosis and were recruited from June 2014 to January 2016. These patients underwent endoscopic transforaminal decompression. The clinical symptoms were evaluated by VAS, ODI, and claudication at 3 and 6 months after surgery. The overall clinical efficacy was evaluated using the MacNab score. Yellow ligament thickness and area of the dural sac were examined by MRI. Bony vertebral canal area, real spinal canal area, nerve root canal bony area, nerve root canal real area, distance between the articular joints, and vertebral canal sagittal diameter were examined by CT. The soft tissue invasion ratio of the vertebral canal and the invasion ratio of the nerve root canal were calculated. Correlations between imaging parameters and age, sex, and clinical efficacy were examined. RESULTS:The MacNab scores were excellent in 47% of cases, good in 34%, generally good in 8%, and poor in 11%. VAS, ODI, and claudication were significantly improved compared with the preoperative values (P < 0.01). A significant difference was observed between the 71-81 year age group and the other age groups (P < 0.05). There were good correlations between clinical efficacy and vertebral canal sagittal diameter, distance between the articular joints, soft tissue invasion ratio of the vertebral canal, and invasion ratio of the nerve root canal. CONCLUSION:Treatment of lumbar spinal stenosis by endoscopic transforaminal decompression can achieve good clinical results. This operation is less effective in patients older than 71 years of age. There were positive correlations between clinical efficacy and the vertebral canal sagittal diameter, the articular joints, soft tissue invasion ratio of the vertebral canal, and invasion ratio of the nerve root canal.

Project description:BackgroundLeg pain and back pain after lumbar laminectomy and spinal decompression fusion surgery are common and often related to persistent lumbar foraminal or lateral recess stenosis. Although persistent symptoms often stem from incomplete decompression during the primary index surgery, recurrent symptoms may also be the result of intervertebral cage subsidence due to loss of intervertebral and neuroforaminal height.ObjectiveThe aim of this study was to investigate the feasibility of using the outpatient transforaminal decompression procedure as an alternative to inpatient open procedure in revision decompression surgery, with the intent of minimizing the incidence of perioperative and postoperative surgical complications while reducing both direct and indirect costs of surgical treatment, shortening time to patient postoperative narcotic independence, and shortening time of patient return to daily activities.MethodsA total of 48 patients with conclusive diagnostic imaging and interventional workup underwent endoscopic transforaminal and lateral recess decompression for both persistent or recurrent leg and/or low back pain following previous lumbar laminectomy (22 patients) or decompression fusion surgery (26 patients). In addition to radiographic studies, patients were followed for a minimum of 2 years postoperatively, and clinical outcomes were evaluated with the visual analog scale (VAS), Oswestry Disability Index (ODI), and modified Macnab criteria.ResultsAt final follow-up, patients with single- and 2-level prior surgeries reported an average ODI reduction following their secondary surgery of 44.6%, with an average final score of 14.8. Less favorable ODI score reductions following secondary surgery (23.8%) were reported by patients who had more than one or a complex prior multilevel surgery. According to the modified Macnab criteria, "excellent" and "good" results were obtained with the secondary surgery in 79.1% (38 of 48) of patients with no more than a single 1- or 2-level prior lumbar surgery. The mean VAS score decreased from 7.7 ± 1.8 preoperatively to 2.3 ± 1.1 at final follow-up (P < .01). Fair and poor results with the secondary surgery were seen in 20.9% (10 of 48) of patients with several prior surgeries or complex multilevel previous lumbar surgeries. The level distribution for secondary surgery was as follows: L4-5 segment (26 levels; 54.1%), L5-S1 (14 levels; 29.2%), L3-4 (7 levels; 14.6%), and the L2-3 level (1 level; 2.1%). Postoperative complications were limited to irritation of the dorsal root ganglion, which occurred in 25% (12 of 48) of patients. There were no wound infections, nerve root injuries, foot drop, or admissions to a hospital for further postoperative care. All patients with "excellent" and "good" outcomes measured by modified Macnab criteria, who were working before and after the primary and secondary surgeries (27 of 38), reported earlier return to work after the endoscopic outpatient surgery (2.6 ± 0.8 weeks) than with the prior inpatient open spinal surgery (8.1 ± 4.5 weeks). Based on the 2012 Medicare fee schedule for professional fees, direct costs were 40.6% and indirect costs were 37.1% lower with the secondary endoscopic surgery compared with primary open surgery.ConclusionsTransforaminal decompression is an effective alternative to open revision lumbar spinal surgery to treat symptomatic spinal stenosis after previous lumbar surgery in patients with persistent or recurrent leg and low back pain. It can be safely done in an outpatient setting, while realizing savings in direct and indirect costs.

Dataset Information

Treatment of Soft Tissue and Bony Spinal Stenosis by a Visualized Endoscopic Transforaminal Technique Under Local Anesthesia.

Objective

Methods

Results

Conclusion

Publications

Treatment of Soft Tissue and Bony Spinal Stenosis by a Visualized Endoscopic Transforaminal Technique Under Local Anesthesia.

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