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Background. During minimally invasive spine surgery, nerve root decompression is challenging due to the anatomical division and uncertainty in lumbar lateral recess (LLR). Objectives. To evaluate the outcome and safety of foraminoplasty using percutaneous transforaminal endoscopic decompression (PTED) (performed with an aid of a trephine) in the treatment of lumbar lateral recess stenosis (LLRS). Materials and methods. All operations were performed under local anesthesia and in prone position. The puncture point was 10-14 cm away from the midline of the spinous process. One hundred eight individuals with LLRS who underwent PTED from September 2016 to December 2020 in our hospital were enrolled in the study. Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores were collected preoperatively after 1 day, 7 days, 1 month and at the final follow-up (June 2021). Low back pain and leg pain were measured using VAS score. Functional outcomes were assessed with ODI and modified Macnab criteria. Results. After the surgery, the VAS score and ODI were statistically significant at all follow-up points compared with the pre-surgery (both p < 0.05). Based on the modified Macnab scores at the final follow-up, the satisfaction rate at postoperative 1 month was 96.3% and the satisfaction rate at postoperative 7 days was 70.38%. A significant difference was observed between the 2 groups (p < 0.05). Conclusions. Foraminoplasty using PTED performed with a trephine is one of the safe and effective, minimally invasive methods to treat LLRS. [ABSTRACT FROM AUTHOR]

Zhendong Lv,* Linyu Jin,* Kun Wang,* Zhi Chen, Fengning Li, Yuhui Zhang, Lifeng Lao, Chun Zhou, Xinfeng Li, Hongxing Shen Department of Spine Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xinfeng Li; Hongxing Shen No. 160 Pujian Road, Shanghai 200127, People’s Republic of ChinaTel +86-18835991449; +86-13601814912Fax +86-021-58395057Email lxfrenji@126.com; shenhxgk@126.comPurpose: Although degenerative lumbar spinal stenosis (LSS) is increasingly being diagnosed in older people, there is much uncertainty about the appropriate operative treatment options. The objective of this study was to compare the outcome of percutaneous endoscopic lumbar decompression (PELD) versus fenestration for lumbar lateral recess stenosis (LRS) in geriatric patients over 75 years old.Materials and methods: This prospective controlled study was performed on 46 consecutive over aged patients with lateral recess stenosis who underwent either PELD or fenestration. Clinical data were recorded before, 1 week, 3 months and 1.5 years after surgery using visual analog scale (VAS), Japanese Orthopaedic Association Score (JOA), The Short-Form-36 (SF-36), and the modified Macnab evaluation criteria.Results: The patients’ mean age was 82.7 years (aged 75–93 years) in PELD group and 79.1 years (aged 75–88 years) in fenestration group. No statistical difference was found between PELD group and fenestration group with regards to VAS-back pain, VAS-leg pain, JOA and at 3 months and 1.5-year follow-up. However, the PELD group had a lower mean VAS for back pain at 1 week postoperatively (P0.05). Operative time (min) was similar between two groups (p>0.05), while the PELD techniques brought advantages in blood loss (mL) (48.3 vs 128.2, p

To report the clinical and radiographic outcomes of 47 patients with bilateral symptomatic lumbar lateral recess stenosis (LLRS) treated with percutaneous spinal endoscopy (PSE) via a unilateral posterior interlaminar approach with bilateral decompression. Forty-seven patients with single-level LLRS and bilateral symptoms who underwent PSE using a unilateral posterior interlaminar approach to perform bilateral decompression between May 2014 and June 2016 were reviewed retrospectively. Surgical-related data were collected, and clinical efficacy was evaluated using the Visual Analogue Scale (VAS) for back and leg pain, the Oswestry Disability Index (ODI), and the single continuous walking distance (SCWD) without pain at preoperative and postoperative time points. Patient satisfaction was evaluated by modified MacNab criteria at the one-year postoperative time point. All patients displayed improvements in clinical symptoms after surgery and were discharged the day of surgery. The mean operation time and blood loss were 91.17 ± 16.81 min and 13.53 ± 4.94 mL, respectively. At a mean follow-up of 18.33 ± 4.16 months, none of the patients required reoperation, while 6 of 47 patients experienced complications. VAS scores for back and leg pain, ODI, and SCWD were significantly improved at all postoperative time points compared with the preoperative values. Satisfactory (excellent or good) results were demonstrated in 44 of 47 patients (93.6%) at the one-year postoperative time point. The percutaneous spinal endoscopic technique via a unilateral posterior interlaminar approach for performing bilateral decompression is a less invasive, effective and safe surgery and can be considered an alternative option for treating patients with bilateral symptomatic LLRS. • A novel percutaneous endoscopic unilateral approach decompression technique was introduced in patients with bilateral LLRS. • The efficacy and safety of this full-endoscopic decompression procedure were evaluated. • Key points of percutaneous spinal endoscopic bilateral decompression via unilateral approach were detailed. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to investigate the surgical strategy, safety, and efficacy of percutaneous endoscopic decompression via transforaminal approach for lumbar lateral recess stenosis in geriatric patients.Methods: From January 2012 to June 2014, 25 elderly patients (18 males and 7 females) with symptomatic lumbar lateral recess stenosis were performed percutaneous endoscopic transforaminal decompression. The ages of patients ranged from 70 to 93 years (mean 79.6 years). Clinical outcomes were assessed mainly by leg pain visual analogue scale (VAS), Oswestry disability index (ODI) score, MacNab criteria, and post-operative computerized tomographic (CT) scanning.Results: The surgery was successfully completed in all patients with an average operation time of 75 minutes (range, 50-110 min). The lumbar CT images at two days after the operation demonstrated distinct enlargement of the foramen intervertebrale as well as satisfactory decompression of the lumbar lateral recess. And 24 patients of the group were followed up for a mean duration of 29 ± six months (range, 12-44 months). The leg pain VAS score decreased from 8.52 ± 1.11 pre-operatively to 1.80 ± 0.63, 1.33 ± 0.89, 1.05 ± 0.69, and 0.71 ± 0.50 at one, three, six and 12 months after the operation, respectively. Besides, the ODI score also dropped from 59.43 ± 10.04 pre-operatively to 29.42 ± 10.33, 20.13 ± 8.18, 13.98 ± 6.16, and 9.86 ± 5.03 at one, three, six and 12 months during the post-operative follow-up period. Statistically significant differences existed in both VAS score and ODI score at each follow-up time point when compared with the pre-operative scores (P < 0.05). The mean reciprocal angulation change of the operated segment in dynamic lumbar lateral view was 3.2° ± 1.6° at the last follow-up. And there were 18 excellent cases, three good cases, and three fair cases according to the MacNab criteria, and the excellent and good rate was 87.5% at 12 months after the operation. There was no aggravation of the coexisting medical conditions after operation in this group. Only 1 case was found complicated with lower extremity numbness, which was recovered by conservative treatment for two weeks. No persistent neurological deficit or soft tissue infection occurred in all patients post-operatively.Conclusions: We considered that percutaneous endoscopic transforaminal decompression achieved satisfactory results and provided a safe, effective, and less invasive alternative for treating lumbar lateral recess stenosis in geriatric patients. [ABSTRACT FROM AUTHOR]

Objective: To investigate the clinical efficacy and safety of percutaneous foraminal endoscopy in the treatment of lumbar lateral recess stenosis in elderly., Methods: The clinical data of 31 elderly patients with lumbar lateral recess stenosis treated by percutaneous foraminal endoscopic decompression from March 2018 to August 2019 were retrospectively analyzed. Including 16 males and 15 females, aged from 65 to 81 years with an average of (71.13±5.20) years, the course of disease ranged from 3 months to 7 years with an average of (14.36±6.52) months. Visual analogue scale (VAS) and Oswestry disability index (ODI) were used to assess clinical symptom and functional status before operation and 1, 6, 12 months after operation. At the final follow-up, the modified Macnab standard was used to evaluate clinical efficacy., Results: All patients were completed the operation successfully. The operation time was from 75 to 120 min with an average of (97.84±11.22 ) min. All 31 patients were followed up from 12 to 28 months with an average of (17.29±5.56) months. Postoperative lumbago-leg pain VAS and ODI were significantly improved at 1, 6, and 12 months( P <0.01). At the final follow-up, according to the modified Macnab standard to evaluate the effect, 23 got excellent results, 5 good, 3 fair. One patient had severe adhesions between peripheral tissues and nerve root, and postoperative sensory abnormalities in the lower extremities were treated conservatively with traditional Chinese medicine and neurotrophic drugs, which recovered at 2 weeks after surgery. No complications such as nerve root injury and infection occurred., Conclusion: The intervertebral foraminal endoscopy technique, which is performed under local anesthesia for a short period of operation, ensures adequate decompression while minimizing complications, and is a safe and effective surgical procedure for elderly patients with lumbar lateral recess stenosis.

Background: During minimally invasive spine surgery, nerve root decompression is challenging due to the anatomical division and uncertainty in lumbar lateral recess (LLR)., Objectives: To evaluate the outcome and safety of foraminoplasty using percutaneous transforaminal endoscopic decompression (PTED) (performed with an aid of a trephine) in the treatment of lumbar lateral recess stenosis (LLRS)., Material and Methods: All operations were performed under local anesthesia and in prone position. The puncture point was 10-14 cm away from the midline of the spinous process. One hundred eight individuals with LLRS who underwent PTED from September 2016 to December 2020 in our hospital were enrolled in the study. Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores were collected preoperatively after 1 day, 7 days, 1 month and at the final follow-up (June 2021). Low back pain and leg pain were measured using VAS score. Functional outcomes were assessed with ODI and modified Macnab criteria., Results: After the surgery, the VAS score and ODI were statistically significant at all follow-up points compared with the pre-surgery (both p < 0.05). Based on the modified Macnab scores at the final follow-up, the satisfaction rate at postoperative 1 month was 96.3% and the satisfaction rate at postoperative 7 days was 70.38%. A significant difference was observed between the 2 groups (p < 0.05)., Conclusions: Foraminoplasty using PTED performed with a trephine is one of the safe and effective, minimally invasive methods to treat LLRS.

Microendoscopic discectomy (MED) is an established procedure used to treat lumbar central spinal stenosis (LCSS) and lateral recess stenosis (LRS). The Interlaminar Endoscopic Surgical System iLESSYS® Delta approach has been developed from the traditional interlaminar endoscopic technique for the treatment of LCSS and LRS. In the present study, MED was used as a reference to evaluate this newly developed approach. A total of 82 and 52 patients with radicular leg pain and/or neurogenic claudication symptoms were treated by spinal canal decompression using the MED or iLESSYS® Delta approach, respectively. The clinical outcomes of the patients were analyzed using the Modified MacNab's criteria, visual analogue scale (VAS) leg pain score, VAS back pain score and the Oswestry Disability Index (ODI) score. Finally, the effectiveness of the decompression was evaluated on a cross-sectional area of the dural sac (CSAD) at the disc level. The incision length in the iLESSYS® Delta group was significantly decreased compared with the MED group (P<0.05); however, the duration of the operation in the iLESSYS® Delta group was significantly longer compared with the MED group (P<0.05). The VAS score of the back and ODI score in the iLESSYS® Delta group were significantly decreased compared with the MED group at the 1-week follow-up (P<0.0125). The postoperative CSAD was also significantly increased in both groups compared with before the operation (P<0.05); however, there were no significant differences in the postoperative CSAD between the two groups. The good-to-excellent rates of the MED and iLESSYS® Delta approach were 89.0 and 90.4%, respectively, whereas the complication rates of the MED and iLESSYS® Delta system were 3.66 and 3.85% in the two groups, respectively. In conclusion, the iLESSYS® Delta approach was identified to be comparable with the MED approach for treating LCSS and LRS, demonstrating both precise and limited decompression. In addition, the iLESSYS® Delta approach may reduce the short-term back pain and promote faster recovery compared with the MED. [ABSTRACT FROM AUTHOR]

Objective: To establish a management strategy for multi-segment lumbar lateral recess stenosis., Methods: A retrospective study was performed in patients in whom suspected responsible nerve roots underwent sequential selective nerve root block (SNRB). Based on pain remission rate after blocking, the contribution of nerve root compression to symptoms was classified as absolutely (≥70%) or relatively (30-70%) responsible or non-responsible (<30%). Conservative treatment was continued if visual analogue scale (VAS) at 3 days after blocking a single nerve root or VAS at 3 days after blocking multiple nerve roots was ≥50%; otherwise, percutaneous transforaminal endoscopic discectomy (PTED) was performed. Pain and functional scores were evaluated on day 3, 6 months and 1 year after SNRB or PTED., Results: Fifty-seven of 80 patients had a single absolutely responsible root, 20 had 2 responsible roots, and 3 had 3 responsible roots. Among them, 41, 10, and 1 patient underwent PTED, respectively. Both the PTED and conservative groups improved significantly in VAS remission rate and functional scores compared with admission. Moreover, the PTED group had a better VAS remission rate compared with the conservative group., Conclusion: A combination of SNRB with PTED was effective for diagnosing and treating multi-segment lumbar lateral recess stenosis.

Objective: To explore the safety and effectiveness of percutaneous transforaminal endoscopic BEIS technology for lumbar lateral recess stenosis in the elderly., Methods: From February 2014 to May 2016, 21 patients with lumbar lateral recess stenosis in elderly were treated with percutaneous endoscopic BEIS. There were 13 males and 8 females, aged from 70 to 85 years old with an average of 74.3 years. Preoperative, 1 and 12 months postoperative visual analogue scale(VAS) scores and Oswestry Disability Index(ODI) were statistically analyzed. MacNab was used to assess the clinical effects., Results: All the operations were successful. The time ranged from 90 to 130 min with an average of 110 min. All the patients were followed up for 12 to 38 months with an average of 18 months. Preoperative, 1 and 12 months postoperative VAS scores were 8.47±1.23, 1.78±0.72, 0.68±0.32, and ODI scores were 32.48±10.03, 19.53±3.55, and 5.15±1.02, respectively. Postoperative scores of VAS and ODI were obviously improved( P <0.05). According to modified MacNab standard to evaluate the clinical effects, 14 cases obtained excellent results, 5 good, 2 fair. Lower limb paresthesia occurred in 1 case, and the condition was restored at 3 months postoperatively with conservative treatment. One patient was complicated with emphysema before operation secondary to pulmonary infection, and was effectively controlled with regulate antibiotic therapy. No infection of vertebral body or intervertebral space, no injuries of blood vessels or nerve root, no tear of dura, or the leakage of cerebrospinal fluid were found., Conclusions: Percutaneous transforaminal endoscopic BEIS is a safe and effective method for lumbar lateral recess stenosis in the elderly., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© 2018 by the China Journal of Orthopaedics and Traumatology Press.)

Objective: To evaluate the outcome and safety of percutaneous lumbar foraminoplasty (PLF) and percutaneous endoscopic lumbar decompression (PELD) with specially designed instrument for lumbar lateral recess stenosis with/without herniated discs (HDs)., Method: From August of 2011 to August of 2013, 96 patients met the inclusion criteria were treated with PLF-PELD and 85 cases were followed up to 2 years postoperatively. MRI or CT checkup performed in the next morning after operation. Outcomes of symptoms were evaluated by follow-up interviews at 3 months, 6 months, 1 year and 2 years after surgery. Low back pain and leg pain were measured by Visual Analog Scale (VAS) score (1-100). Functional outcomes were assessed by using Oswestry Disability Index (ODI) and modified MacNab criteria., Result: Two years follow-up data were obtained from 85 cases, including 14 cases on unilateral L3-4, 1 case on bilateral L3-4, 49 cases on unilateral L4-5, 3 cases on bilateral L4-5, 12 cases on unilateral L5S1, 1 case on bilateral L5S1, 3 cases on unilateral L3-5 and 2 cases on unilateral L4-S1. So totally 95 lumbar lateral recesses were decompressed. Patients ranged in age from 46-78 years (mean age, 56.7 years), including 36 males and 49 females. 56 cases combined with HDs. Low back pain and leg pain were significantly relieved after surgery in all patients. 3 patients were complicated with dysesthesia in distribution of exiting nerve that was all operated at L5S1. Postoperative MRI/CT examination showed adequate decompression of lateral recess and removal of combined HDs in all patients. No patient had postoperative infection, dysfunctional nerve root injury or iatrogenic segmental instability. 2 cases experienced recurrence of combined HDs (2.4%), but could not undertake further revision surgery because of infirm condition. All the 85 cases were analyzed with complete follow-up data. VAS scores and ODI values were significantly lower in all time-points after surgery than before surgery. MacNab scores at 2 years after surgery were obtained from all the 85 patients. 29 cases were given "excellent"; 48 were given "good". 6 patients experienced heavier low back pain, thus being classified as "fair". 2 cases with recurrence were given "poor"., Conclusions: PLF-PELD with specially designed instrument is a less invasive, effective and safe surgery for lumbar lateral recess stenosis with/without combined HDs., (Copyright © 2016 Elsevier B.V. All rights reserved.)