journal article
May 01, 2019
Comparative analysis of three types of minimally invasive decompressive surgery for lumbar central stenosis: biportal endoscopy, uniportal endoscopy, and microsurgery
Abstract
OBJECTIVE
Recently, minimally invasive unilateral laminotomy with bilateral decompression (ULBD) has been performed for lumbar stenosis using endoscopic approaches. The object of this retrospective study was to compare the clinical and radiological outcomes of three types of minimally invasive decompressive surgery: microsurgery, percutaneous uniportal endoscopic surgery, and percutaneous biportal endoscopic surgery.
METHODS
In the period from March 2016 to December 2017, minimally invasive ULBD was performed using microscopy, a uniportal endoscopic approach, or a biportal endoscopic approach to treat lumbar canal stenosis. Patients were classified into three groups based on the surgery they had undergone. The angle of medial facetectomy area and postoperative dural expansion were measured using MR images. The visual analog scale (VAS) score for leg and back pain, Oswestry Disability Index (ODI), operation time, and complications were assessed. Clinical and radiological parameters were compared among the three groups.
RESULTS
There were 33 patients in the microscopy group, 37 in the biportal endoscopy group, and 27 in the uniportal endoscopy group. Preoperatively stenotic dural areas were significantly expanded in each of the three groups after surgery (p < 0.05). Mean dural expansion in the uniportal endoscopy group was significantly lower than that in the microscopy or biportal endoscopy group (p < 0.05). The mean angle of the facetectomy in the biportal endoscopic group was significantly lower than that in the microscopic group or uniportal endoscopic group (p < 0.05). On the 1st day after surgery, the VAS score for back pain was significantly higher in the microscopic group than in the uniportal or biportal endoscopic group (p < 0.05). However, there were no significant differences in the VAS score for back pain, VAS score for leg pain, or ODI at the final follow-up among the three groups (p > 0.05).
CONCLUSIONS
Although radiological results were different among the three groups of patients, postoperative clinical outcomes were significantly improved after each type of surgery. The percutaneous biportal or uniportal endoscopic approach offers the advantage of reduced immediate postoperative pain. A percutaneous uniportal or biportal endoscopic lumbar approach may be effective for the treatment of lumbar central stenosis and an alternative to conventional microsurgical decompression.
Recently, minimally invasive unilateral laminotomy with bilateral decompression (ULBD) has been performed for lumbar stenosis using endoscopic approaches. The object of this retrospective study was to compare the clinical and radiological outcomes of three types of minimally invasive decompressive surgery: microsurgery, percutaneous uniportal endoscopic surgery, and percutaneous biportal endoscopic surgery.
METHODS
In the period from March 2016 to December 2017, minimally invasive ULBD was performed using microscopy, a uniportal endoscopic approach, or a biportal endoscopic approach to treat lumbar canal stenosis. Patients were classified into three groups based on the surgery they had undergone. The angle of medial facetectomy area and postoperative dural expansion were measured using MR images. The visual analog scale (VAS) score for leg and back pain, Oswestry Disability Index (ODI), operation time, and complications were assessed. Clinical and radiological parameters were compared among the three groups.
RESULTS
There were 33 patients in the microscopy group, 37 in the biportal endoscopy group, and 27 in the uniportal endoscopy group. Preoperatively stenotic dural areas were significantly expanded in each of the three groups after surgery (p < 0.05). Mean dural expansion in the uniportal endoscopy group was significantly lower than that in the microscopy or biportal endoscopy group (p < 0.05). The mean angle of the facetectomy in the biportal endoscopic group was significantly lower than that in the microscopic group or uniportal endoscopic group (p < 0.05). On the 1st day after surgery, the VAS score for back pain was significantly higher in the microscopic group than in the uniportal or biportal endoscopic group (p < 0.05). However, there were no significant differences in the VAS score for back pain, VAS score for leg pain, or ODI at the final follow-up among the three groups (p > 0.05).
CONCLUSIONS
Although radiological results were different among the three groups of patients, postoperative clinical outcomes were significantly improved after each type of surgery. The percutaneous biportal or uniportal endoscopic approach offers the advantage of reduced immediate postoperative pain. A percutaneous uniportal or biportal endoscopic lumbar approach may be effective for the treatment of lumbar central stenosis and an alternative to conventional microsurgical decompression.
Topics
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References
30
[1]
Ahn Y: Percutaneous endoscopic decompression for lumbar spinal stenosis. Expert Rev Med Devices 11:605–616, 201425033889
[2]
Alimi M, Hofstetter CP, Pyo SY, Paulo D, Härtl R: Minimally invasive laminectomy for lumbar spinal stenosis in patients with and without preoperative spondylolisthesis: clinical outcome and reoperation rates. J Neurosurg Spine 22:339–352, 201525635635
[3]
Bresnahan LE, Smith JS, Ogden AT, Quinn S, Cybulski GR, Simonian N, : Assessment of paraspinal muscle cross-sectional area after lumbar decompression: minimally invasive versus open approaches. Clin Spine Surg 30:E162–E168, 201728323694
[4]
Guha D, Heary RF, Shamji MF: Iatrogenic spondylolisthesis following laminectomy for degenerative lumbar stenosis: systematic review and current concepts. Neurosurg Focus 39(4):E9, 201526424349
[5]
Heo DH, Kim JS, Park CW, Quillo-Olvera J, Park CK: Contralateral sublaminar endoscopic approach for removal of lumbar juxtafacet cysts using percutaneous biportal endoscopic surgery: technical report and preliminary results. World Neurosurg 122:474–479, 201930458327
[6]
Heo DH, Quillo-Olvera J, Park CK: Can percutaneous biportal endoscopic surgery achieve enough canal decompression for degenerative lumbar stenosis? Prospective case-control study. World Neurosurg 120:e684–e689, 201830165228
[7]
Heo DH, Son SK, Eum JH, Park CK: Fully endoscopic lumbar interbody fusion using a percutaneous unilateral biportal endoscopic technique: technical note and preliminary clinical results. Neurosurg Focus 43(2):E8, 201728760038
[8]
Hwa Eum J, Hwa Heo D, Son SK, Park CK: Percutaneous biportal endoscopic decompression for lumbar spinal stenosis: a technical note and preliminary clinical results. J Neurosurg Spine 24:602–607, 201626722954
[9]
Kim HS, Paudel B, Jang JS, Oh SH, Lee S, Park JE, : Percutaneous full endoscopic bilateral lumbar decompression of spinal stenosis through uniportal-contralateral approach: techniques and preliminary results. World Neurosurg 103:201–209, 201728389410
[10]
Kim SK, Kang SS, Hong YH, Park SW, Lee SC: Clinical comparison of unilateral biportal endoscopic technique versus open microdiscectomy for single-level lumbar discectomy: a multicenter, retrospective analysis. J Orthop Surg Res 13:22, 201829386033
[11]
Komp M, Hahn P, Merk H, Godolias G, Ruetten S: Bilateral operation of lumbar degenerative central spinal stenosis in full-endoscopic interlaminar technique with unilateral approach: prospective 2-year results of 74 patients. J Spinal Disord Tech 24:281–287, 201120975592
[12]
Komp M, Hahn P, Oezdemir S, Giannakopoulos A, Heikenfeld R, Kasch R, : Bilateral spinal decompression of lumbar central stenosis with the full-endoscopic interlaminar versus microsurgical laminotomy technique: a prospective, randomized, controlled study. Pain Physician 18:61–70, 201525675060
[13]
Poletti CE: Central lumbar stenosis caused by ligamentum flavum: unilateral laminotomy for bilateral ligamentectomy: preliminary report of two cases. Neurosurgery 37:343–347, 19957477792
[14]
Storzer B, Schnake KJ: Microscopic bilateral decompression by unilateral approach in spinal stenosis. Eur Spine J 25 (Suppl 2):270–271, 201626931328
[15]
Weinstein JN, Tosteson TD, Lurie JD, Tosteson AN, Blood E, Hanscom B, : Surgical versus nonsurgical therapy for lumbar spinal stenosis. N Engl J Med 358:794–810, 200818287602
[16]
Ahn Y: Percutaneous endoscopic decompression for lumbar spinal stenosis. Expert Rev Med Devices 11:605–616, 201425033889
[17]
Alimi M, Hofstetter CP, Pyo SY, Paulo D, Härtl R: Minimally invasive laminectomy for lumbar spinal stenosis in patients with and without preoperative spondylolisthesis: clinical outcome and reoperation rates. J Neurosurg Spine 22:339–352, 201525635635
[18]
Bresnahan LE, Smith JS, Ogden AT, Quinn S, Cybulski GR, Simonian N, : Assessment of paraspinal muscle cross-sectional area after lumbar decompression: minimally invasive versus open approaches. Clin Spine Surg 30:E162–E168, 201728323694
[19]
Guha D, Heary RF, Shamji MF: Iatrogenic spondylolisthesis following laminectomy for degenerative lumbar stenosis: systematic review and current concepts. Neurosurg Focus 39(4):E9, 201526424349
[20]
Heo DH, Kim JS, Park CW, Quillo-Olvera J, Park CK: Contralateral sublaminar endoscopic approach for removal of lumbar juxtafacet cysts using percutaneous biportal endoscopic surgery: technical report and preliminary results. World Neurosurg 122:474–479, 201930458327
[21]
Heo DH, Quillo-Olvera J, Park CK: Can percutaneous biportal endoscopic surgery achieve enough canal decompression for degenerative lumbar stenosis? Prospective case-control study. World Neurosurg 120:e684–e689, 201830165228
[22]
Heo DH, Son SK, Eum JH, Park CK: Fully endoscopic lumbar interbody fusion using a percutaneous unilateral biportal endoscopic technique: technical note and preliminary clinical results. Neurosurg Focus 43(2):E8, 201728760038
[23]
Hwa Eum J, Hwa Heo D, Son SK, Park CK: Percutaneous biportal endoscopic decompression for lumbar spinal stenosis: a technical note and preliminary clinical results. J Neurosurg Spine 24:602–607, 201626722954
[24]
Kim HS, Paudel B, Jang JS, Oh SH, Lee S, Park JE, : Percutaneous full endoscopic bilateral lumbar decompression of spinal stenosis through uniportal-contralateral approach: techniques and preliminary results. World Neurosurg 103:201–209, 201728389410
[25]
Kim SK, Kang SS, Hong YH, Park SW, Lee SC: Clinical comparison of unilateral biportal endoscopic technique versus open microdiscectomy for single-level lumbar discectomy: a multicenter, retrospective analysis. J Orthop Surg Res 13:22, 201829386033
[26]
Komp M, Hahn P, Merk H, Godolias G, Ruetten S: Bilateral operation of lumbar degenerative central spinal stenosis in full-endoscopic interlaminar technique with unilateral approach: prospective 2-year results of 74 patients. J Spinal Disord Tech 24:281–287, 201120975592
[27]
Komp M, Hahn P, Oezdemir S, Giannakopoulos A, Heikenfeld R, Kasch R, : Bilateral spinal decompression of lumbar central stenosis with the full-endoscopic interlaminar versus microsurgical laminotomy technique: a prospective, randomized, controlled study. Pain Physician 18:61–70, 201525675060
[28]
Poletti CE: Central lumbar stenosis caused by ligamentum flavum: unilateral laminotomy for bilateral ligamentectomy: preliminary report of two cases. Neurosurgery 37:343–347, 19957477792
[29]
Storzer B, Schnake KJ: Microscopic bilateral decompression by unilateral approach in spinal stenosis. Eur Spine J 25 (Suppl 2):270–271, 201626931328
[30]
Weinstein JN, Tosteson TD, Lurie JD, Tosteson AN, Blood E, Hanscom B, : Surgical versus nonsurgical therapy for lumbar spinal stenosis. N Engl J Med 358:794–810, 200818287602
Metrics
222
Citations
30
References
Details
- Published
- May 01, 2019
- Vol/Issue
- 46(5)
- Pages
- E9
Authors
Cite This Article
Dong Hwa Heo, Dong Chan Lee, Choon Keun Park (2019). Comparative analysis of three types of minimally invasive decompressive surgery for lumbar central stenosis: biportal endoscopy, uniportal endoscopy, and microsurgery. Neurosurgical Focus, 46(5), E9. https://doi.org/10.3171/2019.2.focus197
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