Long-Term Functional Outcomes of Endoscopic Decompression with Destandau Technique for Lumbar Canal Stenosis.

STUDY DESIGN: Retrospective study of patients with lumbar canal stenosis (LCS) operated using endoscopic unilateral laminotomy with bilateral decompression (ULBD). PURPOSE: This study aimed to provide a detailed description of the technique of endoscopic decompression in LCS along with a description of the surgical anatomy and its advantages. We also discuss the clinical outcomes in patients operated using this technique. OVERVIEW OF LITERATURE: In 1999, the results with the use of microscopic ULBD were published. Microscopic/microendoscopic decompression using tubular retractor system showed good to excellent results in studies that compared such techniques with midline decompression. The first description of the use of endoscope in spine surgery was in 1988 when it was used for discectomy. With advancements and familiarity with the techniques, full endoscopic surgery has found application in LCS treatment. METHODS: The clinical records of 953 patients who were operated between 1998 and 2008 were analyzed in 2018. Along with patient characteristics, information about return to daily activities, complication rates, and functional outcomes using Prolo score was assessed. RESULTS: L4-L5 was the most common level for which surgery was performed. Two-level decompression was performed in 116 patients; 89.5% patients were able to return to their daily activities after 2 weeks. Functional outcomes as per the Prolo score were reported by patients as excellent, good, and poor in 89.85%, 1.59%, and 8.55%, respectively. Repeat surgery was required at same level in 16 patients and at a different level in 21 patients. Total 605 patients (63.49%) were symptom-free during the 70-month followup, while 344 complained of residual back pain, and four complained of persistent leg pain. CONCLUSIONS: ULBD using the Endospine system achieves adequate decompression in most cases and is a good alternative to open laminectomy, with the advantage of avoiding damage to the structural integrity of the spine and preserving soft tissue attachments.

Endospine Surgery Complications in Lumbar Herniated Disc.

BACKGROUND AND OBJECTIVE: Spine surgery is entering a new era of evolution, with minimally invasive spine surgery to decompress the neural structures without affecting the stability of the spine. However, complications may occur. The surgeon must have these in mind in order to prevent them. We report on the main intraoperative and postoperative complications of endospine surgery of lumbar disc herniation. METHODS: It was a retrospective study spread over 22 years (January 1993-December 2015) concerning 10,433 patients who underwent treatment for lumbar disc herniation at the Endospine Surgery Center Bordeaux France. Among them 1189 patients had 1 intraoperative or postoperative complication. RESULTS: This study comprised 10,433 patients, among whom 1189 had various complications, which represented 11.39%. The average age of this sample was 46 years, and the eldest were 91 years. A male predominance was noted in 6502 of cases with a sex ratio of 6502/3931 = 1.65. The complications were recurrences (6.77%) followed by dural tears (1.91%), facet resection (1.14%), two-level approach instead of one (1.09%), radicular lesion (0.17%) that remained with motor or pain symptoms, wrong level and infections such as spondylodiscitis and wound infection, respectively (0.08%) each, deep vein thrombosis (0.04%), and gauze (0.03%). CONCLUSIONS: Twenty-two years of follow-up on endospine treatment for lumbar disc herniation showed a low complication rate. An early and efficient management will nevertheless allow a good outcome in the majority of patients operated.

Anatomic investigation of lumbar transforaminal fenestration approach and its clinical application in far lateral disc herniation.

Treating lumbar disease at the intervertebal foramina is controversial because we lack an approach providing sufficient exposure and preserving spinal stability. The primary objective of this study was to investigate the feasibility of the transforaminal fenestration (TFF) approach for treating lumbar disease involving the intervertebal foramina.In the anatomic study of 30 adult cadaveric lumbar spine specimens, the TFF approach was used from L1 to S1. The scope of resection was measured manually and on 3D CT images. 3D CT images of the lumbar spine of 31 adult patients were collected, and the scope of resection needed during the TFF approach was defined and measured from L1 to S1. In total, 30 patients (14 men) with lumbar FLDH underwent microendoscopic discectomy (MED) via the TFF approach. The results were evaluated with visual analog scale (VAS), Oswestry Disability Index (ODI), Short Form-36 survey (SF-36), and the MacNab scale.In cadavers, the TFF approach provided sufficient exposure to the posterolateral aspect of the disc and the exiting nerve root at all segments. At L1 to L4, a relatively small part of the isthmus and facet joint was resected; at L4 to S1, a relatively large part of the isthmus and facet joint was resected, so luniform fenestration was needed to preserve a more inferior articular process and continuity of the isthmus. Treatment with MED via the TFF approach was successful in the 30 patients with significantly relieved of symptom after operation. In total, 24 patients were followed for a mean of 24 months. The VAS, ODI, SF-36 physical component, and mental component summary scores at the final follow-up improved significantly compared with preoperative data (P < .05), and excellent results were obtained in 19 patients and good results in 6 according to the Macnab scale.The TFF approach can provide sufficient exposure to the lumbar intervertebal foramina with preservation of stability and can be used effectively with MED to treat lumbar FLDH.

Accuracy and evaluation of irradiation of novel localization devices with unique three-dimensional structures in microendoscopic spine surgery.

BACKGROUND: Although many reports are available on using a variety of instruments and techniques to prevent wrong-level spine surgery, the accurate localization of the correct spinal level remains problematic. At the same time, surgeons are also required to reduce radiation exposure to patients and operating room personnel. To solve these problems, we developed and used specially designed marking devices with a unique three-dimensional structure. PURPOSE: To evaluate the accuracy of our novel devices for localization of the spinal level to prevent wrong-level surgery and reduce the amount and time of radiation exposure during surgery. STUDY DESIGN: This was a retrospective cohort study. METHODS: In 8240 consecutive patients who underwent microendoscopic spine surgery between 1993 and 2012, the incidence of wrong-level surgery was studied. In addition, the amount of radiation exposure and total fluoroscopy time were measured in recent 100 consecutive patients using a digital dosimeter attached to the fluoroscope. RESULTS: Eight (0.097 %) patients had undergone wrong-level surgery. The average radiation exposure was 0.26 mGy (range 0.10-1.15 mGy), and the average total fluoroscopy time was 3.1 s (range 1-7 s). CONCLUSIONS: Our novel localization devices and technique for their use in spine surgery are reliable and accurate for identifying the target level and contributed to reductions in preoperative localization error and radiation exposure to patients and operating room personnel.