A Single Surgeon Experience and Results between Multi-level Lumbar Laminectomy with Microscopic Tubular Approach and Fully-endoscopic Approach: A Report of Over 1000 Cases and up to 6 Years Follow-up

Presented at SMISS Annual Forum 2018
By Jian Shen MD, PhD
With Jordan Guntin BS, Kaitlyn Cardinal BS, Brittany Haws MD, Benjamin Khechen BA, Mundeep Bawa , Harmeet Bawa , Simon Lalehzarian MS, Kern Singh MD,

Disclosures: Jian Shen MD, PhD B; K2M. C; Joimax. Jordan Guntin BS None, Kaitlyn Cardinal BS None, Brittany Haws MD None, Benjamin Khechen BA None, Mundeep Bawa None, Harmeet Bawa None, Simon Lalehzarian MS None, Kern Singh MD A; CSRS Resident Grant. B; DePuy, Zimmer, Stryker, CSRS, ISASS, AAOS, SRS, Vertebral Column - ISASS. D; Avaz Surgical, LLC, Vital 5, LLC. F; Zimmer, Stryker, Pioneer, Lippincott Williams & Wilkins, Th,

Introduction:

The evolution of surgical techniques to decompress the central canal and bilateral lateral recess has been from microscopic/microendoscopic to fully-endoscopic through smaller and smaller incisions with the goal of preserving midline structures and facet function and minimizing complications.

Aims/Objectives:

To compare techniques and clinical outcomes of multi-level lumbar laminectomy with microscopic tubular approach and fully-endoscopic approach.

Methods:

The data of over 1000 patients with multi-level significant lumbar spinal stenosis who underwent bilateral decompression with unilateral approach from August 2011 to December 2017 were retrospectively studied including 829 patients with microscopic tubular approach and 196 patients with fully-endoscopic approach respectively. The data included amount of intraoperative bleeding, operation time/level, hospital stay, and complications. Postoperative follow-up was up to 6 years postoperatively. Low back pain and leg pain were measured by Visual Analog Scale (VAS) score. Functional outcomes were assessed by using Oswestry Disability Index (ODI).

Results:

No patient in either groups had intraoperative nerve injury or postoperative infection. The fully-endoscopic group had significantly less intraoperative bleeding, lower dura tear rate, and shorter hospital stay, but significantly longer operation time/level. The postoperative VAS and ODI scores at each follow-up time point in both groups were significantly improved when compared with the preoperative ones (P < 0.05). Statistically significant difference was found between the 2 groups with the fully-endoscopic group had average better outcomes.

Conclusions:

Both approaches are effective minimally invasive techniques to treat lumbar spinal stenosis. Postoperative improvement and clinical outcomes are similar between 2 approaches. Fully-endoscopic approach has less intraoperative bleeding, lower dura tear rate, shorter hospital stays, yet longer operative time/level.