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Percutaneous endoscopic laminotomy with flavectomy by uniportal, unilateral approach for the lumbar canal or lateral recess stenosis.

Research paper by Chul-Woo CW Lee, Kang-Jun KJ Yoon, Ji-Ho JH Jun

Indexed on: 10 Feb '18Published on: 10 Feb '18Published in: World Neurosurgery



Abstract

The objective of this retrospective study was to evaluate the clinical feasibility and safety of percutaneous endoscopic decompression by uniportal, unilateral approach for the lumbar canal or lateral recess stenosis.The procedure was performed with endoscopic instruments in the same way as with conventional microscopic laminotomy and flavectomy. Clinical outcomes (VAS, ODI, modified MacNab criteria) were evaluated. Surgical outcomes including operative time, hospital stay and complications were also investigated.A total of 213 patients (232 lumbar levels) were decompressed for spinal canal or lateral recess stenosis (Unilateral laminotomy: 80; Bilateral laminotomy: 152). The mean follow-up period was 26.45 months. The mean VAS for leg pain, and back pain and the mean ODI improved from 8.24, 5.35, and 67.8% at baseline to 1.93 (P < 0.001), 2.05 (P < 0.001), and 17.14 % (P < 0.001) at final follow-up, all respectively. Based on the modified MacNab criteria, excellent or good results were obtained in 93.8 % of the patients. Average operation time was 105.3±56 minutes. In the late period of the learning curve, the mean operation time was shortened by two thirds, and the mean hospital stay was 2.45 days. There were twelve cases of transient postoperative dysthesia, three cases of motor weakness and six cases of dura tear. No patient developed postoperative infection, hematoma or needed for revision surgery for incomplete decompression.Percutaneous endoscopic decompression by uniportal, unilateral approach is a safe, clinically feasible and effective surgical technique for the treatment of lumbar stenosis.