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Early outcomes of 270-degree spinal canal decompression by using TESSYS-ISEE technique in patients with lumbar spinal stenosis combined with disk herniation

  • Chengjie Xiong
  • Tao Li
  • Hui Kang
  • Hao Hu
  • Jing Han
  • Feng Xu
Original Article

Abstract

Purpose

Traditional open approach is an efficient way to treat lumbar spinal stenosis (SS) combined with disk herniation (DH); however, risk factors such as advanced age, osteoporosis etc. are associated with the complications after the surgery. This study aims to analyze the early clinical and radiological outcomes of treatment on SS&DH by using newly developed minimal invasive TESSYS-ISEE technique.

Methods

Patients with limp and unilateral lower limb radiculopathy underwent minimal invasive surgery by using TESSYS-ISEE technique. The visual analogue scale score (VAS) and Oswestry Disability Index (ODI) were evaluated before operation and 1, 3, 6 and 12 months after surgery. The clinical global outcomes were also evaluated using modified MacNab criteria after surgery.

Results

A total of 32 cases underwent operation by using TESSYS-ISEE technique from December 2016 to December 2017. The mean age for the study group was 53.9 ± 11.14 years and the ratio between male and female was 1.29:1; Mean follow-up of the study was 7.78 ± 3.48 months and mean estimated blood loss was 11.41 ± 4.79 mL per-level. VAS leg score improved from 8.44 ± 0.98 to 2.18 ± 0.75 (P < 0.001), VAS back score improved from 4.44 ± 0.95 to 1.57 ± 0.54 (P < 0.001), and ODI improved from 73.88 ± 5.95 to 29.04 ± 7.48 (P < 0.001). The success rate was 90.7%. There were no serious complications during follow-up. Two patients experienced dysesthesia and one patient required revision surgery.

Conclusions

It is safe and minimal-invasively to treat SS&DH by using TESSYS-ISEE technique. However, potential complications still require careful consideration and further evaluation.

Graphical abstract

These slides can be retrieved under Electronic Supplementary material.

Keywords

Endoscopy Disk herniation Lateral recess stenosis Central stenosis Nerve root decompression 

Notes

Acknowledgements

This work is supported by the Natural Science Foundation of China (Grant No 81401802) and the funds from National Health and Family Planning Commission of Wuhan Municipality and China Postdoctoral Science Foundation (Grant No 2016M593043).

Authors contribution

CX and FX worked on conception and study design. HK and HH performed the operation. CX played a role in data analysis and interpretation. TL and JH drafted the manuscript. All authors played a role in critical review and revision of final manuscript for important intellectual content.

Conflict of interest

No conflict of interest was declared.

Supplementary material

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Supplementary material 1 (PPTX 834 kb)

Supplementary material 2 (MP4 381411 kb)

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Supplementary material 3 (TIFF 97 kb)
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Supplementary material 4 (JPEG 27 kb)
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Supplementary material 5 (JPEG 26 kb)

References

  1. 1.
    Genevay S, Atlas SJ (2010) Lumbar spinal stenosis. Best Pract Res Clin Rheumatol 24:253–265CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Phillips FM, Slosar PJ, Youssef JA, Andersson G, Papatheofanis F (2013) Lumbar spine fusion for chronic low back pain due to degenerative disc disease: a systematic review. Spine 38:E409–E422CrossRefPubMedGoogle Scholar
  3. 3.
    Foley KT (1997) Microendoscopic discectomy. Tech Neurosurg 3:301–307Google Scholar
  4. 4.
    Xu Bs TQ, Xia Q, Ji N, Yc Hu (2010) Bilateral decompression via unilateral fenestration using mobile microendoscopic discectomy technique for lumbar spinal stenosis. Orthop Surg 2:106–110CrossRefPubMedGoogle Scholar
  5. 5.
    Yeung AT, Tsou PM (2002) Posterolateral endoscopic excision for lumbar disc herniation: surgical technique, outcome, and complications in 307 consecutive cases. Spine 27:722–731CrossRefPubMedGoogle Scholar
  6. 6.
    Yoon SM, Ahn S-S, Kim KH, Kim YD, Cho JH, Kim D-H (2012) Comparative study of the outcomes of percutaneous endoscopic lumbar discectomy and microscopic lumbar discectomy using the tubular retractor system based on the VAS, ODI, and SF-36. Korean J Spine 9:215–222CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Kim HS, Paudel B, Jang JS, Oh SH, Lee S, Park JE, Jang IT (2017) Percutaneous full endoscopic bilateral lumbar decompression of spinal stenosis through uniportal-contralateral approach: techniques and preliminary results. World Neurosurg 103:201–209CrossRefPubMedGoogle Scholar
  8. 8.
    Kim HS, Patel R, Paudel B, Jang J-S, Jang I-T, Oh S-H, Park JE, Lee S (2017) Early outcomes of endoscopic contralateral foraminal and lateral recess decompression via an interlaminar approach in patients with unilateral radiculopathy from unilateral foraminal stenosis. World Neurosurg 108:763–773CrossRefPubMedGoogle Scholar
  9. 9.
    Schizas CTN, Burn A, Tansey R, Wardlaw D, Smith FW, Kulik G (2010) Qualitative grading of severity of lumbar spinal stenosis based on the morphology of the dural sac on magnetic resonance images. Spine 35:1919–1924CrossRefPubMedGoogle Scholar
  10. 10.
    Wiltse LL, Newman PH, Macnab I (1976) Classification of spondylolisis and spondylolisthesis. Clin Orthop 117:23–29Google Scholar
  11. 11.
    George Sapkas M, Mavrogenis AF, Konstantinos AS, Konstantinos S, Zinon TK, Panayiotis JP (2012) Outcome of a dynamic neutralization system for the spine. Orthopedics 35:e1497–e1502CrossRefPubMedGoogle Scholar
  12. 12.
    Macnab I (1971) Negative disc exploration: an analysis of the causes of nerve-root involvement in sixty-eight patients. JBJS 53:891–903CrossRefGoogle Scholar
  13. 13.
    Simmons ED Jr, Kowalski JM, Simmons EH (1993) The results of surgical treatment for adult scoliosis. Spine 18:718–724CrossRefPubMedGoogle Scholar
  14. 14.
    Daffner SD, Vaccaro AR (2003) Adult degenerative lumbar scoliosis. Am J Orthop (Belle Mead, NJ) 32:77–82; discussion 82Google Scholar
  15. 15.
    Hasegawa K, Homma T (2003) One-stage three-dimensional correction and fusion: a multilevel posterior lumbar interbody fusion procedure for degenerative lumbar kyphoscoliosis: technical note. J Neurosurg Spine 99:125–131CrossRefGoogle Scholar
  16. 16.
    Pritchett JW, Bortel DT (1993) Degenerative symptomatic lumbar scoliosis. Spine 18:700–703CrossRefPubMedGoogle Scholar
  17. 17.
    Zander TRA, Klöckner C, Bergmann G (2003) Influence of graded facetectomy and laminectomy on spinal biomechanics. Eur Spine J 12:427–434CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Yagi MOE, Ninomiya K, Kihara M (2009) Postoperative outcome after modified unilateral-approach microendoscopic midline decompression for degenerative spinal stenosis. J Neurosurg Spine 10:293–299CrossRefPubMedGoogle Scholar
  19. 19.
    Castro-Menéndez MB-RJ, Casal-Moro R, Hernández-Blanco M, Jorge-Barreiro F (2009) Treatment of lateral recess stenosis by means of microendoscopic decompressive laminotomy results at one year. Revista española de cirugía ortopédica y traumatología (English edition) 53:242–249CrossRefGoogle Scholar
  20. 20.
    Manfrè L, Cartolari R, Trasimeni G, Cristaudo C (2007) Spinal instability—axial loaded imaging of the spine. In: Van Goethem JWM, van den Hauwe L, Parizel PM (eds) Spinal imaging. Medical radiology (Diagnostic imaging). Springer, Berlin, Heidelberg, pp 211–233Google Scholar
  21. 21.
    Epstein JACR, Ferrar J, Hyman RA, Khan A (1981) Conjoined lumbosacral nerve roots: management of herniated discs and lateral recess stenosis in patients with this anomaly. J Neurosurg 55:585–589CrossRefPubMedGoogle Scholar
  22. 22.
    Postacchini FCG, Perugia D, Gumina S (1993) The surgical treatment of central lumbar stenosis. Multiple laminotomy compared with total laminectomy. Bone Joint J 75:386–392Google Scholar
  23. 23.
    Ruetten SKM, Godolias G (2005) An extreme lateral access for the surgery of lumbar disc herniations inside the spinal canal using the full-endoscopic uniportal transforaminal approach-technique and prospective results of 463 patients. Spine 30:2570–2578CrossRefPubMedGoogle Scholar
  24. 24.
    Ruetten SKM, Merk H, Godolias G (2008) Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine 33:931–939CrossRefPubMedGoogle Scholar
  25. 25.
    Ruetten SKM, Godolias G (2006) A new full-endoscopic technique for the interlaminar operation of lumbar disc herniations using 6-mm endoscopes: prospective 2-year results of 331 patients. min-Minimally Invasive. Neurosurgery 49:80–87Google Scholar
  26. 26.
    Choi KCKJRK et al (2013) Percutaneous endoscopic lumbar discectomy for L5-S1 disc herniation: transforaminal versus interlaminar approach. Pain Phys 16:547–556Google Scholar
  27. 27.
    Hamanishi C, Matukura N, Fujita M, Tomihara M, Tanaka S (1994) Cross-sectional area of the stenotic lumbar dural tube measured from the transverse views of magnetic resonance imaging. J Spinal Disord Tech 7:388–393Google Scholar
  28. 28.
    Weiner BK, Walker MA, Patel NM (2007) Outcomes of decompression for lumbar spinal canal stenosis based upon preoperative radiographic severity. J Orthop Surg Res 2:3CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Ahn Y (2012) Transforaminal percutaneous endoscopic lumbar discectomy: technical tips to prevent complications. Expert Rev Med Devices 9:361–366CrossRefPubMedGoogle Scholar
  30. 30.
    Parker SL, Adogwa O, Paul AR, Anderson WN, Aaronson O, Cheng JS, McGirt MJ (2011) Utility of minimum clinically important difference in assessing pain, disability, and health state after transforaminal lumbar interbody fusion for degenerative lumbar spondylolisthesis. J Neurosurg Spine 14:598–604CrossRefPubMedGoogle Scholar
  31. 31.
    Komp M, Hahn P, Merk H, Godolias G, Ruetten S (2011) Bilateral operation of lumbar degenerative central spinal stenosis in full-endoscopic interlaminar technique with unilateral approach: prospective 2-year results of 74 patients. Clin Spine Surg 24:281–287Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Orthopaedic DepartmentWuhan General Hospital of PLAWuhanChina
  2. 2.Orthopaedic DepartmentHubei Province Traditional Chinese Medicine CollegeWuhanChina

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