Uniportal Endoscopic Transforaminal Discectomy Associated with Cylindrical Percutaneous Interspinous Spacer

Background: The benefits from endoscopic spine surgery are well documented in literature. The use of interspinous spacers remains controversial, but the results reported in the studies just compare open decompression versus indirect decompression with interspinous spacers. Percutaneous cylindrical interspinous spacer portal is recommended at 16 cm from midline and endoscopic transforaminal discectomy from 10-12 cm. The risk of using an extreme lateral portal is greater. The literature recommends general anesthesia for interspinous instrumentation. We hypothesized that patients could benefit from a minimal invasive endoscopic decompression and an indirect decompression using the same portal for endoscopic transforaminal discectomy and the interspinous spacer instrumentation changing the introduction angle. This will reduce the recovery time, reoperation rate, soft tissue damage, anesthetic risk, and the possibility of damage to abdominal and retroperitoneal organs. Methods: We collected data from 152 consecutive patients from January 2008 to June 2016. All patients were candidates for endoscopic transforaminal discectomy and/or foraminoplasty and had surgical indications for interspinous spacer instrumentation. Mild sedation and local anesthesia was used during the endoscopic procedure. The interspinous spacer instrumentation was performed with local or epidural anesthesia. Results: Of the 152 patients that had the minimum 2 years follow up, we lost 10 patients at the end. Another 7 had another surgery. Average age was 49 years old, 80 males and 72 females. A total of 214 lumbar interspinous spacers were used. 84 patients referred their primary problem was axial pain (facets/discs) and 68 radicular pain (with central and/or foraminal stenosis). VAS lumbar pain dropped from 7.2 to 0.8 at 2 years, radicular pain from 6.1 to 0.4. The preoperatory ODI was 54.8 and went down to 12.4 at 24 months. More than 90% of the patients reported excellent or good results. Conclusion: No complications associated with the combination of both procedures. In proper selected cases, the uses of interspinous spacers and endoscopic transforaminal decompression have good results. Minimally invasive procedures can help patients to prevent or retard a greater surgery like fusion or laminectomy. Citation: Cantu-Leal R, Cantu-Longoria R (2018) Uniportal Endoscopic Transforaminal Discectomy Associated with Cylindrical Percutaneous Interspinous Spacer. J Spine 7: 420. doi: 10.0142/2165-7939.1000420