A Less Invasive Approach Technique for Operative Treatment of Lumbar Canal Stenosis

Abstract

The aim of this prospective study is to evaluate the efficacy of a less invasive approach for the operative treatment of lumbar canal stenosis. Using transmuscular dilatation this technique minimises surgical trauma. Through a working channel with a 11 mm outer diameter and under operative microscope guidance, decompression of the neural elements can be achieved.
Material and Methods: From November 1998 to December 2001 38 consecutive patients with a mean age of 73.2 years were operated upon using this technique. The study included 56 lumbar segments. The mean follow up was 32 (18-55) months. The Visual Analogue Scale (VAS) for back and leg pain together with the Oxford Claudication Score (OCS) were used to assess the functional results.
Results: The average operating time for one level decompression was 74 minutes and the average blood loss was 32 ml/patient. Two patients (5.2 %) required revision by open surgery. The OCS improved from 29.4 preoperatively to 16.9 postoperatively (p < 0.001). VAS for back pain and leg pain also showed a significant improvement (p < 0.001).
Conclusions: This less invasive approach is effective in decompressing lumbar canal stenosis. It has the advantage of early mobilisation and a short hospital stay, especially in elderly patients (mean age here: 73.2 years).

Zusammenfassung

Ziel dieser prospektiven Studie ist es, eine minimal-invasive Zugangstechnik zur operativen Behandlung von Lumbalkanalstenosen zu bewerten. Ein Arbeitskanal (11 mm Außendurchmesser) wird über transmuskuläre Dilatation eingebracht. Die Dekompression der neuralen Strukturen erfolgt unter dem Operationsmikroskop.
Material und Methode: 38 konsekutive Patienten mit einem Altersdurchschnitt von 73,2 Jahren wurden im Zeitraum November 1998 bis Dezember 2001 in 56 lumbalen Segmenten mit dieser Technik operiert. Der Nachbeobachtungszeitraum betrug 32 (18-55) Monate. Zur Objektivierung der funktionellen Ergebnisse wurden die Visuelle Analog Skala (VAS), differenziert nach Rücken- und Beinschmerz, sowie der Oxford Claudication Score (OCS) verwendet.
Ergebnisse: Die mittlere Operationsdauer pro Segment betrug 74 Minuten, der mittlere Blutverlust pro Patient 32 ml. Zwei Patienten (5,2 %) mussten revidiert werden. Sowohl der OCS (29,4 präoperativ, 16,9 postoperativ) als auch die VAS verbesserten sich postoperativ signifikant (p < 0,001).
Schlussfolgerungen: Mit dieser Technik kann eine effektive Dekompression erreicht werden. Durch das geringe Zugangstrauma ist eine rasche Mobilisation der vorwiegend älteren Patienten (Altersmittel 73,2 Jahre) und ein verkürzter Krankenhausaufenthalt möglich.

Lumbar canal stenosis - minimally invasive approach - microscopically assisted - decompression

Lumbalkanalstenose - minimalinvasiver Zugang - mikroskopisch assistiert - Dekompression

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