Bilateral Decompression in Lumbar Spinal Stenosis through a Unilateral Posterior Endoscopic Approach. Surgical technique and results about 723 cases.
Jean DESTANDAU – Marjory RUE
Correspondance to : Jean DESTANDAU, 138 avenue de la République. 33200 BORDEAUX France, Tel: (33) 556 51 51 60,
e-mail : jean.destandau@wanadoo.fr
Study Design: This endoscopic surgical technique has been used by the first author since 1993 for disc prolapses and since 2001 for lumbar spinal stenosis. Surgical technique is described and results of 723 cases are presented as well as long term results.
Material and Methods: The device (Endospine, Karl Storz GmbH, Tuttlingen, Germany) is composed of three tubes: one for the endoscope, one for suction canula and the largest one for classical surgical instruments. Since 2001 this endoscopic technique has been used in spinal stenosis performing a bilateral décompression through a unilateral posterior approach on the left side or on the side of prédominant signs. From February 2001 to December 2015, 723 patients have been operated on with this technique. In 87% surgery was a single level décompression and in 17% there was an associated spondylolisthesis. Prolo’s criteria were used. A key point is to determin how many levels have to be operated. In this study 629 patients underwent a single level approach.
Results: 542 questionnaires (75%) were returned showing excellent results in 487 cases (90%) and poor in 48 (9%). With an average delay of 2 weeks, 482 patients (89%) returned to a normal life. Sixteen patients (3%) needed a second operation with an average delay of 27 months. The complications observed were: dural tear in 50 (6,9%); nerve root lesion in 4 (0,5%); resection of articular process in 28 (4%); wrong level décompression in 2 (0,7%); and 5 compressive hematoma (0,7%) ; no infection. In answer to the questions on global satisfaction and on the accuracy of the information given before surgery, 98% responded as satisfied and felt the information given to be accurate.
Conclusions: This minimally invasive technique is mainly used in single level spinal stenosis even with associated spondylolisthesis, but can be also used in several levels décompression. The good results and the fast resumption of normal activities explain that this endoscopic technique could become the gold standard in spinal stenosis, pathology that is increasing with the lifespan extension. The option to treat as less levels as possible looks good as rate of reoperations is quite low.
