Minim Invasive Neurosurg 2011; 54(3): 142-146
DOI: 10.1055/s-0031-1279716
Technical Note

© Georg Thieme Verlag KG Stuttgart · New York

Minimally Invasive Technique for Decompression of Lumbar Foraminal Stenosis Using a Spinal Microendoscope: Technical Note

M. Yoshimoto1 , T. Takebayashi1 , S. Kawaguchi1 , H. Tsuda1 , K. Ida1 , T. Wada1 , D. Suzuki2 , T. Yamashita1
  • 1Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
  • 2Department of Anatomy, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
Further Information

Publication History

Publication Date:
23 August 2011 (online)

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.

References

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  • 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; 
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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