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. 2016 Nov 28:22:4604-4611.
doi: 10.12659/msm.901686.

Suprapedicular Foraminal Endoscopic Approach to Lumbar Lateral Recess Decompression Surgery to Treat Degenerative Lumbar Spinal Stenosis

Ya-Peng Wang  1 , Wei Zhang  1 , Bao-Li Li  1 , Ya-Peng Sun  1 , Wen-Yuan Ding  1 , Yong Shen  1
Affiliations

Suprapedicular Foraminal Endoscopic Approach to Lumbar Lateral Recess Decompression Surgery to Treat Degenerative Lumbar Spinal Stenosis

Ya-Peng Wang et al. Med Sci Monit. .

Abstract

BACKGROUND To discuss the strategy of suprapedicular foraminal endoscopic approach to lumbar lateral recess decompression and evaluate the safety and effectiveness of this strategy. MATERIAL AND METHODS Complete clinical information of 52 cases of lumbar lateral recess decompression with therapy of suprapedicular foraminal endoscopic approach were analyzed during the period from February 2010 to April 2014 in the Third Hospital of Hebei. All patients were followed up for 24 months, and VAS, JOA, ODI, and LRD were compared between preoperative and postoperative therapy and changes of FA. Intraoperative and postoperative complications were recorded and the safety of the surgery was evaluated. The surgical "excellent" and "good" rates were evaluated using MacNab score. RESULTS VAS scores for lumbago and leg pain at 3, 6, 12, and 24 months after surgery were significantly lower than before surgery (p<0.05). JOA scores at 12 and 24 months after surgery were significantly higher than before surgery (p<0.05). ODI at 12 and 24 months after surgery were significantly lower than before surgery (p<0.05). LRD after surgery was higher (p<0.05), and FA was lower than before surgery. CONCLUSIONS Use of the suprapedicular foraminal endoscopic approach to lumbar lateral recess decompression is safe and effective, and this minimally invasive treatment can achieve satisfactory results, especially for elderly patients with complicated underlying diseases.

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Conflict of interest statement

All authors declare that there is no conflict of interest.

Figures

Figure 1
Figure 1
Selective nerve root closed surgery combined with CT and MRI of lumbar disc determined distribution of responsible segments.
Figure 2
Figure 2
A) A. Puncture schematic route of narrow lateral recess, from the facet tip to the bottom of the pedicle. B. Puncture schematic route of traditional TESSYS technology. (B) Guild bar puncture from the facet tip to the bottom of the pedicle.
Figure 3
Figure 3
Removed hypertrophy of yellow ligament and facet to expand the intervertebral foramen using trepan.
Figure 4
Figure 4
a. Decompression structure of ventral nerve roots. b. Decompression structure of dorsal nerve root.
Figure 5
Figure 5
Schematic diagram of working channel adjustment. a, b. Working channel adjustment from disc level to the upper edge of lower vertebral pedicle.
Figure 6
Figure 6
Female, 71 years old, left leg pain for 3 years with intermittent claudication. (A) Preoperative MRI of lumbar showed multi-segment degeneration. (B) Preoperative CT of lumbar showed the left nerve root canal stenosis of L4–5 segments. Before surgery LRD=0.39 cm, FA=1.25 cm2. After surgery, CT showed decompression of the left nerve root canal of L4–5 segments. After surgery, LRD=0.80 cm, FA=0.95cm2. LRD – lateral recess diameter; FA – facet area. (C) Placed the working channel. Dotted line area is lateral recess area that can be depressurized using the suprapedicular approach.
Figure 7
Figure 7
VAS score of Preoperative and postoperative follow-up of back pain. A. 1 day before surgery. B. 3 months after surgery. C. 6 months after surgery. D. 12 months after surgery. E. 24 months after surgery.
Figure 8
Figure 8
VAS score of preoperative and postoperative follow-up of leg pain. A. 1 day before surgery. B. 3 months after surgery. C. 6 months after surgery D. 12 months after surgery. E. 24 months after surgery.
Figure 9
Figure 9
Excellent rate of surgery.
See this image and copyright information in PMC

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