Clinical analysis of lumbar lateral recess stenosis with the full-endoscopic visualized decompression via a superior vertebral notch approach

English Keywords:Lateral recess stenosis  Superior vertebral notch approach  Full-endoscopic  Visualized

English Abstract:

  【Abstract】 Objectives: To evaluate the clinical outcomes and key points of the full-endoscopic(FE) visualized decompression via a superior vertebral notch approach for the treatment of lumbar lateral recess stenosis. Methods: 96 cases with lumbar lateral recess stenosis that underwent the FE visualized decompression via a superior vertebral notch approach from June 2016 to December 2017 in our hospital were enrolled. There were 62 males and 34 females, with an average age of 51.4±13.3 years(38-68 years). The preoperative visual analog scale(VAS) scores of low back pain and leg pain were 0-5(3.8±1.6) and 3-7(5.2±1.0), respectively. The preoperative Oswestry disability index(ODI) was 38％-65％[(53.0±9.1)%]. The preoperative angle and anteroposterior diameter of the lateral recess were 17.6°±1.4° and 2.3±0.2mm, respectively. All patients were followed up for 2 years at least. The VAS scores of low back pain and leg pain, and lumbar ODI were evaluated and analyzed at 1 week, 3 months, 1 year and final follow-up postoperatively. The surgical effectiveness was assessed according to the modified MacNab criteria at final follow-up. Results: 96 cases were successfully completed the operation. The average operation time was 55.8±14.6min; the average times of radiation was 7.2±2.5; the average length of hospital stay was 3.7±1.9 days. One case occurred temporary paralysis who recovered after a conservative treatment within 1 week. 6 cases remained residual symptoms, and 4 cases didn′t show any improvement after surgery. 6 cases had to undergo revision surgery finally. The postoperative angle and anteroposterior diameter of the lateral recess were 39.5°±4.2° and 6.2±0.4mm, significantly increased comparing with pre-operation(P<0.01). The postoperative VAS scores for low back and leg pain, as well as the ODI at 1 week, 3 months, 1 year and final follow-up were obviously improved when compared with pre-operation(P<0.05). All patients were followed up, the follow-up time was 24－32 months(26.6±5.6 months). Based on the modified MacNab scores at final follow-up, 32 cases were classified as excellent; 54 cases were good; 6 cases were fair; 4 cases were poor, with 89.6% of the satisfactory rate. Conclusions: The FE visualized decompression via a superior vertebral notch approach is an effective and safe surgery for lumbar lateral recess stenosis and is able to achieve satisfactory short-term results. However, the indications need to be strictly selected, to avoid affecting the improvement of clinical outcomes.