Efficacy of Endoscopic Surgery in Management of Patients with Lumbar Canal Stenosis

Abstract

Background Data: The treatment of lumbar stenosis has originally included extensive resections of posterior neural arch components. Moreover, wide muscular dissection and retraction is generally used to accomplish sufficient visualization. With the advancing noninvasive neuro-imaging modalities; the major component of neurological pressure typically occurs at the level of the interlaminar window. Microendoscopic decompressive laminotomies (MEDL) have now increased popularity among spine specialists for the treatment of lumbar canal stenosis. It has been developed from the unilateral hemilaminotomy technique.Purpose: To evaluate the efficacy of lumbar endoscopic decompression in patients of segmental lumbar canal stenosis from a unilateral skin incision.Study Design: A prospective clinical case study.Patients and Methods: A total of 30 patients 10 males and 20 females were operated in Alexandria Main University Hospital, during the period from January 2013 to June 2015. The degree of pain and disability were assessed pre-operatively using the Visual Analogue Scale (VAS), both for radicular pain and back pain (if present), and the Oswestry Disability Index (ODI). The length of the incision, the duration of surgery, the operative blood loss, and duration of hospital stay were calculated. Mean follow up period for patients was 38.5±18.2 months (Range, 36-48).Results: The mean age was 62.7±6.9 years. All patients had claudicating sciatica; 57% had bilateral sciatica, while 43 % had unilateral sciatica. 60% had low back pain. Only 3 patients (10%) had motor weakness preoperatively. 24 patients (80%) had single level affection, while 6 patients (20%) had double level affection. We operated totally on 36 segmental levels. There was a statistically significant reduction for the mean values of VAS both for radicular pain and back pain in the follow up period (P<0.001). Also, there was a statistically significant reduction for the ODI mean value in the follow up period (P<0.001). Operative blood loss was 109.5±63.2 ML. Mean operative time was 103.8±32.7 minutes. Mean duration of hospital stay was 1.5±0.6 days (Range, 1-3 days). We had two patients of intraoperative dural tears (7%) with no postoperative CSF leak occurred, two patients (7%) had superficial wound infection, no patients had deep wound infection or discitis, and no patients encountered of postoperative instability in the follow up period. Conclusion: Endoscopic surgery for bilateral decompression through a unilateral approach is a useful and effective procedure for treating patients with lumbar canal stenosis with encouraging results. (2018ESJ161)