Percutaneous endoscopic decompression of the central degenerative stenoses of the lumbosacral spine
https://doi.org/10.17650/1683-3295-2024-26-4-14-21
Аннотация
Background. Degenerative stenosis of the spinal canal is a condition observed mostly in the elderly. It significantly decreases their quality of life and physical activity. Surgical treatment of the patients is frequently associated with significant surgical and anesthesiologic risks especially during conventional open decompression. The problem of decreasing invasiveness of surgical interventions is important for these patients because in their case lighter postoperative injury and decreased recovery duration after surgery are crucial.
Aim. To evaluate clinical outcomes in patients with central degenerative lumbosacral stenoses after percutaneous endoscopic decompression.
Materials and methods. Comparison of clinical and radiological characteristics before surgery, on day 1 and month 6 after surgery was performed. Among clinical characteristics, pain syndrome in the leg / legs per the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) were evaluated. The evaluated radiological characteristic was the spinal canal cross-sectional area (CSA) in cm2 per the magnetic resonance imaging. Statistical analysis was performed using the SPSS Statistics v. 26.0 (IBM, USA) software.
Results. Pain syndrome in the leg / legs (decreased VAS score) after surgery decreased significantly (р = 0.006). No significant difference between the VAS scores on day 1 and 6 months after the surgery was found (adjusted significance level padj = 1.000). Similarly, disability index changes were statistically significant after surgery (р = 0.005): ODI score decreased. Additionally, no statistically significant differences between ODI score on day 1 and 6 months after surgery were observed (padj = 1.000). Increase in CSA of the spinal canal was statistically significant (р = 0.001), no differences in this parameter on day 1 and 6 months after surgery were found. Conversion to microsurgical access was necessary in 4 (23.5 %) of 17 patients. No statistically significant differences in VAS, ODI scores and CSA changes at different time points were observed in patients who required conversion.
Conclusion. Results of the study show significant improvement of the patients’ clinical status (per the VAS and ODI) and achievement of adequate radiological decompression (increased spinal canal CSA) which persisted for 6 months after percutaneous endoscopic interventions.
Ключевые слова
Об авторах
A. R. YusupovaРоссия
Adilya Rinatovna Yusupova
125367; 80 Volokolamskoye Shosse; Moscow
A. O. Gushcha
Россия
125367; 80 Volokolamskoye Shosse; Moscow
S. O. Arestov
Россия
125367; 80 Volokolamskoye Shosse; Moscow
D. V. Petrosyan
Россия
125367; 80 Volokolamskoye Shosse; Moscow
Список литературы
1. Jensen R.K., Jensen T.S., Koes B., Hartvigsen J. Prevalence of lumbar spinal stenosis in general and clinical populations : a systematic review and meta-analysis. Eur Spine J 2020;29(9): 2143–63. DOI: 10.1007/s00586-020-06339-1
2. Deyo R.A., Mirza S.K., Martin B.I. et al. Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA 2010;303(13):1259–65. DOI: 10.1001/jama.2010.338
3. Surgery of degenerative spinal lesions: national guidelines. Ed. by A.O. Guschya, N.A. Konovalova, A.A. Grin. Moscow: GEOTAR-Media, 2019. 480 p. (In Russ.).
4. Volkov I.V., Karabaev I.Sh., Ptashnikov D.A. et al. Outcomes of transforaminal endoscopic discectomy for lumbosacral disc herniation. Travmatologiya i ortopediya Rossii = Traumatology and orthopedics of Russia 2017;23(3):32–42. (In Russ.). DOI: 10.21823/2311-2905-2017-23-3-32-42
5. Konovalov N.A., Asiutin D.S., Korolishin V.A. et al. Percutaneous endoscopic discectomy in the treatment of patients with degenerative diseases of the lumbosacral spine. Zhurnal Voprosy neyrokhirurgii im. N.N. Burdenko = Burdenko’s Journal of Neurosurgery 2017;81(5):56–62. (In Russ., In Engl.) DOI: 10.17116/neiro201781556-62
6. Meredzhi A.M., Orlov A.Yu., Nazarov A.S. et al. Percutaneous endoscopic transforaminal and interlaminar lumbar discectomy for cranially migrated disc hernia. Khirurgiya Pozvonochnika = Russian Journal of Spine Surgery 2020;17(3):81–90. (In Russ.). DOI: 10.14531/ss2020.3.81-90
7. Basankin I.V., Porkhanov V.A., Takhmazyan K.K. et al. Transpedicular endoscopic removal of highly migrated disc herniations of lumbar spine. Neyrokhirurgiya = Russian Journal of Neurosurgery 2020;22(3):42–50. (In Russ.). DOI: 10.17650/1683-3295-2020-22-3-42-50
8. Kim H.S., Patel R., Paudel B. et al. Early outcomes of endoscopic contralateral foraminal and lateral recess decompression via an interlaminar approach in patients with unilateral radiculopathy from unilateral foraminal stenosis. World Neurosurgery 2017;108:763–73. DOI: 10.1016/j.wneu.2017.09.018
9. Wagner R., Haefner M. Indications and contraindications of full-endoscopic interlaminar lumbar decompression. World Neurosurg 2021;145:657–62. DOI: 10.1016/j.wneu.2020.08.042
10. Grin A.A., Nikitin А.S., Yusupov S.R. Surgical treatment of spinal canal stenosis at the lumbar level in the elderly and senile patients. Neyrokhirurgiya = Russian Journal of Neurosurgery. 2020;22(1):93–102. (In Russ.). DOI: 10.17650/1683-3295-2020-22-1-93-102
11. Wagner R., Telfeian A.E., Krzok G., Iprenburg M. Fully-endoscopic lumbar laminectomy for central and lateral recess stenosis: technical note. Interdiscipl Neurosurg 2018;13(2):6–9. DOI: 10.1016/j.inat.2018.01.006
12. Hasan S., White-Dzuro B., Barber J.K. et al. The endoscopic trans-superior articular process approach: a novel minimally invasive surgical corridor to the lateral recess. Oper Neurosurg (Hagerstown) 2020;19(1):E1–E10. DOI: 10.1093/ons/opaa054
13. Deer T.R., Grider J.S., Pope J.E. et al. The MIST Guidelines: the lumbar spinal stenosis consensus group guidelines for minimally invasive spine treatment. Pain Pract 2019;19(3):250–74. DOI: 10.1111/papr.12744
14. Kim H.S., Sharma S.B., Raorane H.D. et al. Early results of full-endoscopic decompression of lumbar central canal stenosis by outside-in technique: a clinical and radiographic study. Medicine (Baltimore) 2021;100(39):e27356. DOI: 10.1097/MD.0000000000027356
15. Kim H.S., Paudel B., Jang J.S. et al. Percutaneous full endoscopic bilateral lumbar decompression of spinal stenosis through uniportal-contralateral approach: techniques and prpeliminary results. World Neurosurg 2017;103:201–9.
16. Iprenburg M., Wagner R., Godschalx A., Telfeian A.E. Patient radiation exposure during transforaminal lumbar endoscopic spine surgery: a prospective study. Neurosurg Focus 2016;40 (2):E7. DOI: 10.3171/2015.11.FOCUS15485
17. Carrascosa-Granada A., Velazquez W., Wagner R. et al. Comparative study between uniportal full-endoscopic interlaminar and tubular approach in the treatment of lumbar spinal stenosis: a pilot study. Global 2020;10(2 supple):70S–78S. DOI: 10.1177/2192568219878419.
18. Siepe C.J., Sauer D., Mayer H.M. Full endoscopic, bilateral over-the-top decompression for lumbar spinal stenosis. Eur Spine J 2018;27(Suppl 4):S563–S5. DOI: 10.1007/s00586-018-5656-3
19. Siepe C.J., Sauer D. Technique of full-endoscopic lumbar discectomy via an interlaminar approach. Eur Spine J 2018; 27(Suppl 4):S566–S567. DOI: 10.1007/s00586-018-5657-2
20. Zaina F., Tomkins-Lane C., Carragee E., Negrini S. Surgical versus non-surgical treatment for lumbar spinal stenosis. Cochrane Database Syst Rev 2016;2016(1):CD010264. DOI: 10.1002/14651858.CD010264.pub2
21. Ammendolia C., Stuber K.J., Rok E. et al. Nonoperative treatment for lumbar spinal stenosis with neurogenic claudication. Cochrane Database Syst Rev 2013;8:CD010712. DOI: 10.1002/14651858.CD010712
22. Lurie J.D., Tosteson T.D., Tosteson A. et al. Long-term outcomes of lumbar spinal stenosis: eight-year results of the Spine Patient Outcomes Research Trial (SPORT). Spine 2015;40:63–76.
23. Virk S., Qureshi S. Current concepts in spinal fusion: a special issue. HSS J 2020;16(2):106–7. DOI: 10.1007/s11420-020-09757-5
24. Martin C.R., Gruszczynski A.T., Braunsfurth H.A. et al. The surgical management of degenerative lumbar spondylolisthesis : a systematic review. Spine (Phila Pa 1976) 2007;32(16):1791–8. DOI: 10.1097/BRS.0b013e3180bc219e
25. Kepler C.K., Vaccaro A.R., Hilibrand A.S. et al. National trends in the use of fusion techniques to treat degenerative spondylolisthesis. Spine (Phila Pa 1976) 2014;39(19):1584–9. DOI: 10.1097/BRS.0000000000000486
Рецензия
Для цитирования:
Yusupova A.R., Gushcha A.O., Arestov S.O., Petrosyan D.V. Percutaneous endoscopic decompression of the central degenerative stenoses of the lumbosacral spine. Нейрохирургия. 2024;26(4):14-21. https://doi.org/10.17650/1683-3295-2024-26-4-14-21
For citation:
Yusupova A.R., Gushcha A.O., Arestov S.O., Petrosyan D.V. Percutaneous endoscopic decompression of the central degenerative stenoses of the lumbosacral spine. Russian journal of neurosurgery. 2024;26(4):14-21. https://doi.org/10.17650/1683-3295-2024-26-4-14-21