General Session: Endoscopic Surgery
Presented by: R. Cantu-Leal - View Audio/Video Presentation (Members Only)
R. Cantu-Leal(1), R.A. Cantu-Longoria(1)
(1) Universidad de Monterrey Christus Muguerza Alta Especialidad, Spine Surgery, Monterrey, Mexico
Background: Cylindrical interspinous spacer portal is recommended at 16 cm. From midline and endoscopic transforaminal discectomy from 10-12 cm. The risk of using an extreme lateral portal is greater. The literature recommends general anesthesia for interspinous instrumentation. We hypothesized that using the same portal for endoscopic transforaminal discectomy and the interspinous spacer instrumentation changing the introduction angle, will reduce soft tissue damage, anesthetic risk, and the possibility of abdominal and retroperitoneal organ injury.
Methods: 136 consecutive patients from January 2008 to October 2015. All patients were candidates to endoscopic transforaminal discectomy and/or foraminoplasty and had indications for interespinous spacer instrumentation. Mild sedation and local anesthesia was used during the endoscopic procedure. The interspinous spacer instrumentation was performed with local or epidural anesthesia.
Results: 77 patients with axial pain (discogenic or facet joint pain). 59 patients with neurogenic claudication (central and/or foraminal stenosis). 136 patients / 190 spacers. Single level: 87. Two levels: 44. Three levels: 5. Visual analogue scale (mean) for lumbar pain decreased from 7.2 to 2.5,articular pain from 6.1 to 1.3 at 30 days from the surgery. Oswestry Disability Index (mean) from 54.8 to 18.5 at 30 days. No complications related to the modified technique. Complications related to implants: 8. Just 4 needed revision surgery (1 L5-S1 dislocated intracanal implant require open decompression, 1 dislocated L4-L5 required open decompression, 1 spinous process reabsorption in L4-L5 required open decompression, 1 L5-S1 dislocated laterally required a DIAM spacer).
Conclusions: Achieve the benefits of combining both surgeries with a single portal, that also can be used in 2 or 3 levels. L5-S1 is the most challenging level. We don´t recommend 3 contiguous spacers.