Short-term effectiveness of accurate decompression via foraminoplasty in treatment of lumbar lateral recess stenosis_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Yu ,  KONG Qingquan , SONG Yueming

Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;

Corresponding?author：

KONG Qingquan, Email: kongspine@126.com

Keywords：

Lumbar vertebra; spinal stenosis; foraminoplasty; accurate

DOI：

10.7507/1002-1892.201705076

Video：

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Objective To discuss the effectiveness and the safety of accurate decompression via foraminoplasty in treating lumbar lateral recess stenosis patients who accompanied by disk-flavum ligamentum space and bony lateral recess stenosis, and to analysis the short-term effectiveness of the surgical procedures. Methods Forty-five lumbar lateral recess stenosis patients accompanied by disk-flavum ligamentum space and bony lateral recess stenosis were treated by accurate decompression via foraminoplasty between January 2013 and January 2016. There were 29 males and 16 females with a median age of 58 years (range, 42-82 years). The disease duration was 3-96 months (mean, 24.4 months). The lesion segment included L_{4, 5} in 36 cases and L₅, S₁ in 9 cases. The visual analogue scale (VAS) score of low back pain and leg pain at preoperation and last follow-up were recorded, and the modified Macnab criteria was used to evaluate the effectiveness at last follow-up. Postoperative CT and MRI were reviewed to evaluate the stability and decompression of the lumbar spine. Results All operations were successfully completed. All the 45 patients were followed up 3-18 months (median, 11 months). Dural tear occurred in 2 cases during operation, bone graft removed into the spinal canal in 1 case, postoperative low back pain occurred in 5 cases, and there was no nerve root injury, hematoma formation, or other complications. The leg pain VAS score at last follow-up (0.6±1.2) was significantly improved when compared with preoperative score (5.7±1.4) (t=8.981, P=0.001); and the low back pain VAS scores showed no significant difference between preoperation and last follow-up (1.5±1.3vs. 1.7±1.4;t=0.535, P=0.585). According to the modified Macnab criteria, the results were excellent in 20 cases, good in 22 cases, fair in 2 cases, and poor in 1 case at last follow-up, and the excellent and good rate was 93.3%. Conclusion Accurate decompression via foraminoplasty is an effective, safe, and less invasive way for treating lumbar recess stenosis patients accompanied by disk-flavum ligamentum space and bony lateral recess stenosis.

Citation： WANG Yu, KONG Qingquan, SONG Yueming. Short-term effectiveness of accurate decompression via foraminoplasty in treatment of lumbar lateral recess stenosis. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(11): 1334-1340. doi: 10.7507/1002-1892.201705076 Copy

1.	Lurie J, Tomkins-Lane C. Management of lumbar spinal stenosis. BMJ, 2016, 352: h6234.
2.	Inoue G, Miyagi M, Takaso M. Surgical and nonsurgical treatments for lumbar spinal stenosis. Eur J Orthop Surg Traumatol, 2016, 26(7): 695-704.
3.	Issack PS, Cunningham ME, Pumberger M, et al. Degenerative Lumbar Spinal Stenosis: Evaluation and Management. J Am Acad Orthop Surg, 2012, 20(8): 527-535.
4.	Lee CK, Rauschning W, Glenn W. Lateral lumbar spinal canal stenosis: classification, pathologic anatomy and surgical decompression. Spine (Phila Pa 1976), 1988, 13(3): 313-320.
5.	Lewandrowski KU. " Outside-in” technique, clinical results, and indications with transforaminal lumbar endoscopic surgery: a retrospective study on 220 patients on applied radiographic classification of foraminal spinal stenosis. Int J Spine Surg, 2014, 8:26.
6.	李振宙, 侯樹勛, 商衛林, 等. 經皮內鏡下經椎間孔入路腰椎側隱窩減壓術: 技術要點及 2 年隨訪結果. 中國骨與關節雜志, 2016, 5(5): 333-338.
7.	Macnab I. Negative disc exploration. An analysis of the causes of nerve-root involvement in sixty-eight patients. J Bone Joint Surg (Am), 1971, 53(5): 891-903.
8.	Kambin P, Gellman H. Percutaneous lateral discectomy of the lumbar spine:a preliminary report. Clin Orthop Relat Res, 1983, 174:127-132.
9.	Kambin P. Arthroscopic microdiscectomy. Arthroscopy, 1992, 8(3): 287-295.
10.	周躍, 李長青, 王建, 等. 椎間孔鏡 YESS 與 TESSYS 技術治療腰椎間盤突出癥. 中華骨科雜志, 2010, 30(3): 225-231.
11.	Kitahama Y, Sairyo K, Dezawa A. Percutaneous endoscopic transforaminal approach to decompress the lateral recess in an elderly patient with spinal canal stenosis, herniated nucleus pulposus and pulmonary comorbidities. Asian J Endosc Surg, 2013, 6(2): 130-133.
12.	Kambin P, Casey K, O’Brien E, et al. Transforaminal arthroscopic decompression of lateral recess stenosis. J Neurosurg, 1996, 84(3): 462-467.
13.	Li ZZ, Hou SX, Shang WL, et al. Percutaneous lumbar foraminoplasty and percutaneous endoscopic lumbar decompression for lateral recess stenosis through transforaminal approach: Technique notes and 2 years follow-up. Clin Neurol Neurosurg, 2016, 143:90-94.
14.	Ahn Y. Percutaneous endoscopic decompression for lumbar spinal stenosis. Expert Rev Med Devices, 2014, 11(6): 605-616.
15.	Yeung AT, Tsou PM. Posterolateral endoscopic excision for lumbar disc herniation: Surgical technique, outcome, and complications in 307 consecutive cases. Spine (Phila Pa 1976), 2002, 27(7): 722-731.
16.	Hermantin FU, Peters T, Quartararo L, et al. A prospective, randomized study comparing the results of open discectomy with those of video-assisted arthroscopic microdiscectomy. J Bone Joint Surg (Am), 1999, 81(7): 958-965.
17.	Vital JM, Lavignolle B, Grenier N, et al. Anatomy of the lumbar radicular canal. Anat Clin, 1983, 5(3): 141-151.
18.	Lassale B, Morvan G, Gottin M. Anatomy and radiological anatomy of the lumbar radicular canals. Anat Clin, 1984, 6(3): 195-201.
19.	王沛, 郭世紱. 腰骶神經通道和腰骶神經根病的發病學. 中華骨科雜志, 1996, 16(12): 796-798.
20.	Tender GC, Baratta RV, Voorhies RM. Unilateral removal of pars interarticularis. J Neurosurg Spine, 2005, 2(3): 279-288.
21.	Ruetten S, Komp M, Merk H, et al. Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine (Phila Pa 1976), 2008, 33(9): 931-939.
22.	Ruetten S, Komp M, Hahn P, et al. Decompression of lumbar lateral spinal stenosis: full-endoscopic, interlaminar technique. Oper Orthop Traumatol, 2013, 25(1): 31-46.
23.	Osman SG, Nibu K, Panjabi MM, et al. Transforaminal and posterior decompressions of the lumbar spine. A comparative study of stability and intervertebral foramen area. Spine (Phila Pa 1976), 1997, 22(15): 1690-1695.
24.	Ruetten S, Komp M, Merk H, et al. Surgical treatment for lumbar lateral recess stenosis with the full-endoscopic interlaminar approach versus conventional microsurgical technique: a prospective, randomized, controlled study. J Neurosurg Spine, 2009, 10(5): 476-485.

1. Lurie J, Tomkins-Lane C. Management of lumbar spinal stenosis. BMJ, 2016, 352: h6234.
2. Inoue G, Miyagi M, Takaso M. Surgical and nonsurgical treatments for lumbar spinal stenosis. Eur J Orthop Surg Traumatol, 2016, 26(7): 695-704.
3. Issack PS, Cunningham ME, Pumberger M, et al. Degenerative Lumbar Spinal Stenosis: Evaluation and Management. J Am Acad Orthop Surg, 2012, 20(8): 527-535.
4. Lee CK, Rauschning W, Glenn W. Lateral lumbar spinal canal stenosis: classification, pathologic anatomy and surgical decompression. Spine (Phila Pa 1976), 1988, 13(3): 313-320.
5. Lewandrowski KU. " Outside-in” technique, clinical results, and indications with transforaminal lumbar endoscopic surgery: a retrospective study on 220 patients on applied radiographic classification of foraminal spinal stenosis. Int J Spine Surg, 2014, 8:26.
6. 李振宙, 侯樹勛, 商衛林, 等. 經皮內鏡下經椎間孔入路腰椎側隱窩減壓術: 技術要點及 2 年隨訪結果. 中國骨與關節雜志, 2016, 5(5): 333-338.
7. Macnab I. Negative disc exploration. An analysis of the causes of nerve-root involvement in sixty-eight patients. J Bone Joint Surg (Am), 1971, 53(5): 891-903.
8. Kambin P, Gellman H. Percutaneous lateral discectomy of the lumbar spine:a preliminary report. Clin Orthop Relat Res, 1983, 174:127-132.
9. Kambin P. Arthroscopic microdiscectomy. Arthroscopy, 1992, 8(3): 287-295.
10. 周躍, 李長青, 王建, 等. 椎間孔鏡 YESS 與 TESSYS 技術治療腰椎間盤突出癥. 中華骨科雜志, 2010, 30(3): 225-231.
11. Kitahama Y, Sairyo K, Dezawa A. Percutaneous endoscopic transforaminal approach to decompress the lateral recess in an elderly patient with spinal canal stenosis, herniated nucleus pulposus and pulmonary comorbidities. Asian J Endosc Surg, 2013, 6(2): 130-133.
12. Kambin P, Casey K, O’Brien E, et al. Transforaminal arthroscopic decompression of lateral recess stenosis. J Neurosurg, 1996, 84(3): 462-467.
13. Li ZZ, Hou SX, Shang WL, et al. Percutaneous lumbar foraminoplasty and percutaneous endoscopic lumbar decompression for lateral recess stenosis through transforaminal approach: Technique notes and 2 years follow-up. Clin Neurol Neurosurg, 2016, 143:90-94.
14. Ahn Y. Percutaneous endoscopic decompression for lumbar spinal stenosis. Expert Rev Med Devices, 2014, 11(6): 605-616.
15. Yeung AT, Tsou PM. Posterolateral endoscopic excision for lumbar disc herniation: Surgical technique, outcome, and complications in 307 consecutive cases. Spine (Phila Pa 1976), 2002, 27(7): 722-731.
16. Hermantin FU, Peters T, Quartararo L, et al. A prospective, randomized study comparing the results of open discectomy with those of video-assisted arthroscopic microdiscectomy. J Bone Joint Surg (Am), 1999, 81(7): 958-965.
17. Vital JM, Lavignolle B, Grenier N, et al. Anatomy of the lumbar radicular canal. Anat Clin, 1983, 5(3): 141-151.
18. Lassale B, Morvan G, Gottin M. Anatomy and radiological anatomy of the lumbar radicular canals. Anat Clin, 1984, 6(3): 195-201.
19. 王沛, 郭世紱. 腰骶神經通道和腰骶神經根病的發病學. 中華骨科雜志, 1996, 16(12): 796-798.
20. Tender GC, Baratta RV, Voorhies RM. Unilateral removal of pars interarticularis. J Neurosurg Spine, 2005, 2(3): 279-288.
21. Ruetten S, Komp M, Merk H, et al. Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine (Phila Pa 1976), 2008, 33(9): 931-939.
22. Ruetten S, Komp M, Hahn P, et al. Decompression of lumbar lateral spinal stenosis: full-endoscopic, interlaminar technique. Oper Orthop Traumatol, 2013, 25(1): 31-46.
23. Osman SG, Nibu K, Panjabi MM, et al. Transforaminal and posterior decompressions of the lumbar spine. A comparative study of stability and intervertebral foramen area. Spine (Phila Pa 1976), 1997, 22(15): 1690-1695.
24. Ruetten S, Komp M, Merk H, et al. Surgical treatment for lumbar lateral recess stenosis with the full-endoscopic interlaminar approach versus conventional microsurgical technique: a prospective, randomized, controlled study. J Neurosurg Spine, 2009, 10(5): 476-485.

Chinese Journal of Reparative and Reconstructive Surgery

Short-term effectiveness of accurate decompression via foraminoplasty in treatment of lumbar lateral recess stenosis

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