Treatment of lumbar canal stenosis by a microscopic assisted percutaneous approach

Prospective study on the efficacy of a microscopically assisted less invasive approach for the operative treatment of lumbar canal stenosis. Less invasive techniques e.g. percutaneous endoscopic and microscopic assisted procedures play now an important role in spine surgery. The advantage of these techniques is to minimize the surgical trauma and accordingly the surgical stress to which the patient is subjected. This is valuable in elderly patients, as lumbar canal stenosis is usually associated with other systemic diseases that add risk to the operative intervention. The aim of this study is to evaluate the efficacy of this minimal invasive approach as an alternative for the operative treatment of lumbar canal stenosis. 50 consecutive patients with a mean age of 72.26 years were operated upon using this technique. The study included 70 lumbar segments. The mean follow up period was 21.58 months. The Visual Analogue Scale [VAS] for back and leg pain together with Oxford Claudication Score [OCS] were used to assess the patients pre-operatively as well as post-operatively. The average operative time for one level decompression was 81 minutes and the average blood loss was 50 ml/patient. Three patients [6%] were revised by open surgery. The OCS showed statistically significant improvement from 28.84 pre-operatively to 14.8 post-operatively [p<0.0001]. VAS for back pain and leg pain showed also statistically significant improvement [p < 0.0001]. This percutaneous technique is effective in decompressing lumbar canal stenosis. It carries the advantage of early mobilization and rehabilitation especially in elderly patients

less invasive posterior technique for the treatment of cervical radiculopathy and myelopathy

Posterior cervical foraminotomy allows decompression of the nerve root with preservation of the motion. Conventional posterior approaches have the disadvantage of detaching the extensor cervical muscles from the laminae and the spinous processes. The aim of this work is to present a new minimally invasive posterior approach avoiding detachment of muscles for the treatment of cervical radiculopathy and myelopathy. Twenty-five patients suffering from cervical radiculopathy [12 patients] and myelopathy [13 patients] were operated according to this technique. In principle, this technique secures access to the diseased spinal segment via a percutaneously placed working channel [11 mm outer diameter and 9 mm inner diameter]. The cervical paraspinal muscles are not deflected, but just spread between their fibres by special dilators. All further steps are performed through this channel under control of 3-dimensional vision through the operating microscope. The average follow up period was 15 months, and patients were evaluated using a modified version of Oswestry Index, called the Neck Disability Index [NDI] and the Visual Analogue Scale [VAS] for neck and arm pain. The mean NDI [P< 0.0001] improved from 38.89 [pre-operative] to 9.43 [post-operative]. The VAS for arm pain [P<0.001] and for neck pain [P<0.001] showed also marked post-operative improvement. Complete recovery of the pre-operative neurological deficit was found in 7 patients while the remaining 18 patients showed improvement of the neurological symptoms during the follow up period. There were no intra-operative or post-operative complications and no re-operation. The preliminary experience with this technique seems to promise, that this less invasive technique is a valid alternative to the conventional open exposure for treatment of lateral disc prolapses, foraminal bony stenosis and central posterior ligamentous stenosis of the cervical spine