Skip to main content
SpringerLink
Log in

Clinical and radiological outcomes of endoscopic partial facetectomy for degenerative lumbar foraminal stenosis

  • Original Article - Spine
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

Several different techniques exist to treat degenerative lumbar foraminal stenosis. Failure to adequately decompress the lumbar foramen may lead to failed back surgery syndrome. However, wide decompression often causes spinal instabilities or may require an additional fusion surgery. The aim of this study was to report the outcomes of endoscopic partial facetectomy (EPF) performed on patients with degenerative lumbar foraminal stenosis.

Methods

Between 2012 and 2014, 25 consecutive patients (12 women and 13 men) who underwent EPF were included in the study. The patients were assessed before surgery and followed-up regularly during outpatient visits (preoperatively and 1, 3, 6, 12, and 24 months postoperatively). The clinical outcomes were evaluated using the visual analog scale (VAS), Oswestry Disability Index (ODI), and Short Form-36 (SF-36) outcome questionnaire. The radiological outcome was measured using the lumbar Cobb angle, disc wedging angle, lumbar lordosis (LL), slip percentage, and disc height index (DHI) in plain standing radiographs.

Results

The VAS, ODI, and SF-36 scores significantly improved at 1 month of follow-up compared with the baseline mean values and were maintained within the 2-year follow-up period. There was no radiologic progression in the lumbar Cobb’s angle, disc wedging angle, LL, slip percentage, and DHI between preoperatively and 2 years postoperatively. In addition, the EPF with discectomy group and the EPF group were not significantly different in terms of clinical and radiological outcomes.

Conclusions

EPF is an effective option in decompressing the lumbar exiting nerve root without causing spinal instabilities for the treatment of patients with lumbar foraminal stenosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Abumi K, Panjabi MM, Kramer KM, Duranceau J, Oxland T, Crisco JJ (1990) Biomechanical evaluation of lumbar spinal stability after graded facetectomies. Spine 15:1142–1147

    Article  CAS  PubMed  Google Scholar 

  2. Adams MA, Hutton WC (1981) The relevance of torsion to the mechanical derangement of the lumbar spine. Spine 6:241–248

    Article  CAS  PubMed  Google Scholar 

  3. Ahn Y, Kim CH, Lee JH, Lee SH, Kim JS (2013) Radiation exposure to the surgeon during percutaneous endoscopic lumbar discectomy: a prospective study. Spine 38:617–625

    Article  PubMed  Google Scholar 

  4. Ahn Y, Oh HK, Kim H, Lee SH, Lee HN (2014) Percutaneous endoscopic lumbar foraminotomy: an advanced surgical techinique and clinical outcomes. Neurosurgery 75:124–133

    Article  PubMed  PubMed Central  Google Scholar 

  5. Burton CV, Kirkaldy-Willis WH, Yong-Hing K, Heithoff KB (1981) Causes of failure of surgery on the lumbar spine. Clin Orthop Relat Res 157:191–199

    Google Scholar 

  6. Epstein NE (2002) Foraminal and far lateral lumbar disc herniations: surgical alternatives and outcome measures. Spinal Cord 40:491–500

    Article  CAS  PubMed  Google Scholar 

  7. Fujiwara A, An HS, Lim TH, Haughton VM (2001) Morphologic changes in the lumbar intervertebral foramen due to flexion-extension, lateral bending, and axial rotation: an in vitro anatomic and biomechanical study. Spine 26:876–882

    Article  CAS  PubMed  Google Scholar 

  8. Garrido E, Connaughton PN (1991) Unilateral facetectomy approach for lumbar disc herniation. J Neurosurg 74:754–756

    Article  CAS  PubMed  Google Scholar 

  9. Hasegawa T, An HS, Haughton VM, Nowicki BH (1995) Lumbar foraminal stenosis: critical heights of the intervertebral disc and foramina. A cryomicrotome study in cadevera. J Bone Joint Surg Am 77:32–38

    Article  CAS  PubMed  Google Scholar 

  10. Haufe SM, Mork AR (2007) Effects of unilateral endoscopic facetectomy on spinal stability. J Spinal Disord Tech 20:146–148

    Article  PubMed  Google Scholar 

  11. Inoue H, Ohmori K, Miyasaka K, Hosoe H (1999) Radiographic evaluation of the lumbosacral disc height. Skelet Radiol 28:638–643

    Article  CAS  Google Scholar 

  12. Inufusa A, An HS, Lim TH, Hasegawa T, Haughton VM, Nowicki BH (1996) Anatomic changes of the spinal canal and intervertebral formen associated with flexion-extension movement. Spine 21:2412–2420

    Article  CAS  PubMed  Google Scholar 

  13. Jenis LG, An HS (2000) Spine update. Lumbar foraminal stenosis. Spine 25:389–394

    Article  CAS  PubMed  Google Scholar 

  14. Kang K, Rodriguez-Olaverri JC, Schwab F, Hashem J, Razi A, Farcy JP (2014) Partial facetectomy for lumbar foraminal stenosis. Adv Orthop 2014:534658. doi:10.1155/2014/534658

    Article  PubMed  PubMed Central  Google Scholar 

  15. Knight MT, Vajda A, Jakab GV, Awan S (1998) Endoscopic laser foraminoplasty on the lumbar spine—early experience. Minim Invasive Neurosurg 41:5–9

    Article  CAS  PubMed  Google Scholar 

  16. Kunogi J, Hasue M (1991) Diagnosis and operative treatment of intraforaminal and extraforaminal nerve root compression. Spine 16:1312–1320

    Article  CAS  PubMed  Google Scholar 

  17. Natarajan RN, Adnersson GB, Patwardhan AG, Andriacchi TP (1999) Study on effect of graded facetectomy on change in lumbar motion segment torsional flexibility using three-dimensional continuum contact representation for facet joints. J Biomech Eng 121:215–221

    Article  CAS  PubMed  Google Scholar 

  18. Nathan H, Weizenbluth M, Halperin N (1982) The lumbosacral ligament (LSL), with special emphasis on the “lumbosacral tunnel” and the entrapment of the 5th lumbar nerve. Int Orthop 6:197–202

    Article  CAS  PubMed  Google Scholar 

  19. Ploumis A, Transfeldt EE, Gilbert TJ Jr, Mehbod AA, Dykes DC, Perra JE (2006) Degenerative lumbar scoliosis: radiographic correlation of lateral ratatory olisthesis with neural canal dimensions. Spine 31:2353–2358

    Article  PubMed  Google Scholar 

  20. Porter RW, Hibbert C, Evans C (1984) The natural history of root entrapment syndrome. Spine 9:418–421

    Article  CAS  PubMed  Google Scholar 

  21. Reulen HJ, Pfaundler S, Ebeling U (1987) The lateral microsurgical approach to the “extracanalicular” lumbar disc herniation. I: A technical note. Acta Neurochir (Wein) 84:64–67

    Article  CAS  Google Scholar 

  22. Schubert M, Hoogland T (2005) Endoscopic transforaminal nucleotomy with foramnioplasty for lumbar disk herniation. Oper Orthop Traumatol 17:641–661

    Article  PubMed  Google Scholar 

  23. Sharma M, Langrana NA, Rodriguez J (1995) Role of ligaments and facets in lumbar spinal stability. Spine 20:887–900

    Article  CAS  PubMed  Google Scholar 

  24. Shenouda EF, Gill SS (2002) Laminal fenestration for the treatment of lumbar nerve root foraminal stenosis. Br J Neurosurg 16:494–496

    Article  CAS  PubMed  Google Scholar 

  25. Taillard W (1954) Spondylolisthesis in children and adolescents. Acta Orthop Scand 24:115–144

    Article  CAS  PubMed  Google Scholar 

  26. Wildermuth S, Zanetti M, Duewell S, Schmid MR, Romanowski B, Benini A, Boni T, Hodler J (1998) Lumbar spine: quantitative and qualitative assessment of positional (upright flexion and extension) MR imaging and myelography. Radiology 207:391–398

    Article  CAS  PubMed  Google Scholar 

  27. Wiltse LL, Spencer CW (1988) New uses and refinements of the paraspinal approach to the lumbar spine. Spine 13:696–706

    Article  CAS  PubMed  Google Scholar 

  28. Wiltse LL, Guyer RD, Spencer CW, Glenn WV, Porter IS (1984) Alar transverse process impingement of the L5 spinal nerve: the far-out syndrome. Spine 9:31–41

    Article  CAS  PubMed  Google Scholar 

  29. Yamada K, Matsuda H, Cho H, Habunaga H, Kono H, Nakamura H (2013) Clinical and radiological outcomes of microscopic partial pediculectomy for degenerative lumbar forminal stenosis. Spine 38:E723–E731

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Myungeun Hospital, 184 World Cup-daero, Yeonje-gu, Busan, 611-800, South Korea

    Myung Soo Youn

  2. Department of Orthopaedic Surgery, Biomedical Research Institute, Pusan National University School of Medicine, 179 Gudeok-ro, Seo-gu, Busan, 602-739, South Korea

    Jong Ki Shin, Tae Sik Goh & Jung Sub Lee

Authors
  1. Myung Soo Youn
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jong Ki Shin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tae Sik Goh
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jung Sub Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jung Sub Lee.

Ethics declarations

Funding

No funding was received for this research.

Conflict of interest

None

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study formal consent is not required.

This article does not contain any studies with human participants performed by any of the authors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Youn, M.S., Shin, J.K., Goh, T.S. et al. Clinical and radiological outcomes of endoscopic partial facetectomy for degenerative lumbar foraminal stenosis. Acta Neurochir 159, 1129–1135 (2017). https://doi.org/10.1007/s00701-017-3186-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-017-3186-0

Keywords

Search

Navigation