Affiliation:
1. Center for Spine Surgery and Pain Therapy, Center for Orthopaedics and Traumatology of the St. Elisabeth Group – Catholic Hospitals RheinRuhr, St. Anna Hospital Herne/ Marienhospital Herne University Hospital/ Marien Hospital Witten, Germany
Abstract
Background: Extensive decompression with laminectomy, where appropriate, is often still
described as the method of choice when operating on degenerative lumbar spinal stenosis.
Nonetheless, tissue-sparing procedures are becoming more common. Endoscopic techniques
have become the standard in many areas because of the surgical advantages they offer and the
benefits for rehabilitation. One key issue when operating on the spine was the development
of instruments to provide sufficient bone resection under continuous visual control. This was
achieved by using endoscopes for operations carried out in cases of spinal canal stenosis.
Objective: This study of patients with degenerative lumbar central spinal stenosis compares
the results of spinal decompression using the full-endoscopic interlaminar technique (FI) with
a conventional microsurgical laminotomy technique (MI).
Study Design: Prospective, randomized, controlled study.
Settings: 135 patients with microsurgical or full-endoscopic decompression were followed
up for 2 years. Alongside general and specific parameters, the following measuring instruments
were also used for the investigation: Visual Analog Scale (VAS), German version of the North
American Spine Society Instrument (NASS), Oswestry Low-Back-Pain-Disability Questionnaire
(ODI).
Results: Postoperatively 72 % of the patients no longer had leg pain or the pain was almost
completely reduced and 21.2 % experienced occasional pain. The clinical results were the
same in both groups. The rate of complications and revisions was significantly reduced in
the FI Group. The full-endoscopic techniques brought advantages in the following areas:
operation, complications, traumatization, rehabilitation.
Limitations: Lack of placebo control group.
Conclusions: The recorded results demonstrate that the full-endoscopic interlaminar
bilateral decompression adopting a unilateral approach provides an adequate and safe
supplement and alternative to the conventional microsurgical bilateral laminotomy technique
when the indication criteria are fulfilled. At the same time, it offers the advantages of a
minimally invasive intervention.
Key words: Spinal stenosis, central stenosis, spinal decompression, endoscopic spinal
decompression, minimally invasive spine surgery
Publisher
American Society of Interventional Pain Physicians
Subject
Anesthesiology and Pain Medicine