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DOI: 10.1055/s-0031-1279716
© Georg Thieme Verlag KG Stuttgart · New York
Minimally Invasive Technique for Decompression of Lumbar Foraminal Stenosis Using a Spinal Microendoscope: Technical Note
Publication History
Publication Date:
23 August 2011 (online)
![](https://www.thieme-connect.de/media/min/201103/lookinside/thumbnails/10.1055-s-0031-1279716-1.jpg)
Abstract
Background: Lumbar foraminal stenosis is a troublesome disease. Decompression of the whole length of the nerve root from the spinal canal to extraforaminal zone is often a surgical requirement due to the difficulty in identifying the nerve compression site before surgery, making preservation of the posterior elements difficult. The authors report a minimally invasive microendoscopic technique for lumbar foraminal stenosis to decompress the entire length of the nerve root from the spinal canal to the extraforaminal zone while preserving the posterior elements.
Surgical Procedure: A tubular retractor is inserted towards the base of the transverse process of the upper vertebra with the retractor tilted inward at a 45-degree angle or greater. Approximately one-third of the pedicle is resected caudally from the base of the transverse process to the spinal canal. After identification of the nerve root, compression factors around the nerve are excised from the spinal canal to the extraforaminal zone without damaging posterior elements such as the facet joints and pars interarticularis.
Results: We treated 6 patients with lumbar foraminal stenosis using this procedure. There were no complications during the operation, and satisfactory results were obtained in all cases.
Conclusions: This microendoscopic technique proved to be useful for the treatment of lumbar foraminal stenosis.
Key words
lumbar foraminal stenosis - minimally invasive spine surgery - microendoscopic surgery - lumbar spine
References
- 1 Foley KT, Smith MM. Microendoscopic discectomy. Techniques in Neurosurgery 3.. Philadelphia: Lippincott-Raven; 1997: 301-307
- 2 Yoshimoto M, Takebayashi T, Tsuda H. et al . Microendoscopic muscle-preserving interlaminar decompression for lumbar spinal canal stenosis. Paper presented at the 9th Pacific and Asian Society of Minimally Invasive Spine Surgery, Osaka, Japan, August 6–8, 2009;
- 3 Yuguchi T, Nishio M, Akiyama C. et al . Posterior microendoscopic surgical approach for the degenerative cervical spine. Neurol Res. 2003; 25 17-21
- 4 Foley KT, Smith MM, Rampersaud YR. Microendoscopic approach to far-lateral lumbar disc herniation. Neurosurg Focus. 1999; 7 E5
- 5 Matsumoto M, Chiba K, Ishii K. et al . Microendoscopic partial resection of the sacral ala to relieve extraforaminal entrapment of the L-5 spinal nerve at the lumbosacral tunnel. J Neurosurg Spine. 2006; 4 342-346
- 6 Kunogi J, Hasue M. Diagnosis and operative treatment of intraforaminal and extraforaminal nerve root compression. Spine. 1991; 16 1312-1320
- 7 Burton CV, Kirkaldy-Willis WH, Yong-Hing K. et al . Causes of failure of surgery on the lumbar spine. Clin Orthop Relat Res. 1981; 157 191-199
- 8 Wiltse LL, Spencer CW. New uses and refinements of the paraspinal approach to the lumbar spine. Spine. 1988; 13 696-706
- 9 Yoshimoto M, Terashima Y, Kawaguchi S. et al . Microendoscopic discectomy for extraforaminal lumbar disc herniations. Jpn J Spine Research Society. 2008; 19 305 (in Japanese)
Appendix
Japanese Orthopaedic Association score for low back pain
I. subjective symptoms | ||||
low back pain |
none |
3 | ||
occasional mild pain |
2 | |||
occasional severe pain |
1 | |||
continuous severe pain |
0 | |||
leg pain |
none |
3 | ||
occasional slight pain |
2 | |||
occasional severe pain |
1 | |||
continuous severe pain |
0 | |||
walking ability |
normal |
3 | ||
able to walk farther than 500 m although it results in symptoms |
2 | |||
unable to walk farther than 500 m |
1 | |||
unable to walk farther than 100 m |
0 | |||
II. objective findings | ||||
straight leg raising test |
normal |
2 | ||
30°–70° |
1 | |||
<30° |
0 | |||
sensory disturbance |
none |
2 | ||
slight disturbance (not subjective) |
1 | |||
marked disturbance |
0 | |||
motor disturbance |
normal |
2 | ||
slight weakness (grade 4 of 5 in manual muscle-testing) |
1 | |||
marked weakness (grade 3–0 of 5 in manual muscle-testing) |
0 | |||
III. activity of daily living |
very difficult |
Difficult |
Easy | |
turn over while lying |
0 |
1 |
2 | |
standing |
0 |
1 |
2 | |
washing face |
0 |
1 |
2 | |
leaning forward |
0 |
1 |
2 | |
sitting (about 1 h) |
0 |
1 |
2 | |
lifting or holding heavy objective |
0 |
1 |
2 | |
walking |
0 |
1 |
2 | |
IV. bladder function |
normal |
0 | ||
mild dysuria |
−3 | |||
severe dysuria |
−6 | |||
total |
29 points |
Correspondence
M. YoshimotoMD
Department of Orthopaedic
Surgery
Sapporo Medical University
School of Medicine
S1 W16
Sapporo
Hokkaido 060-8543
Japan
Phone: +81/11/611 2111
Fax: +81/11/641 6026
Email: myoshimo@sapmed.ac.jp