General Session: Innovative Technologies

Presented by: J. Sclafani - View Audio/Video Presentation (Members Only)

Author(s):

J. Sclafani(1), K. Raiszadeh(1), C. Kim(1)

(1) Spine Institute of San Diego, San Diego, CA, United States

Abstract

Background: Intradiscal endoscopic procedures achieve decompression through indirect techniques. Intracanal endoscopic procedures (IC) utilize a more lateral transforaminal approach to allow direct decompression of the spinal canal. Previous studies have demonstrated positive long term clinical outcomes when IC is used to treat lumbar disc herniation. This study is an assessment of patient outcomes after IC is utilized to treat either recurrent stenosis or multilevel pathology.

Methods: Post-hoc analysis was performed on a previously validated MIS Prospective Registry database containing pre-op and post-op health related quality of life measures for 1032 patients. Subgroups of patients treated with the endoscopic IC technique for decompression of multiple levels (IC-1) or for revision of a previous decompression procedure at the same level (IC-2) were identified. Statistical analysis of VAS and ODI surveys was performed using paired t-tests (p< 0.05).

Results: A total of 9 IC-1 patients and 10 IC-2 patients were analyzed. Median hospital stay was 0 days and there were no intraoperative complications for either group. Group IC-1 (multilevel procedures) showed improvement in ODI (pre-op: 47.3 ± 27.8, post-op one-year: 31.1 ± 22.7, p=0.01, n=9) and VAS of the affected leg or legs (pre-op: 6.6 ± 3.1, post-op one-year: 3.4 ± 3.1, p=0.004, n=14) but did not demonstrate significant improvement in VAS back pain (pre-op: 5.6 ± 3.8, post-op one-year: 3.6 ± 3.8, p=0.14, n=9). Group IC-2 (revision decompression) showed improvement in ODI (pre-op: 44.6 ± 27.4, post-op one-year: 28.2 ± 28.7, p=0.03, n=10), VAS of the affected leg or legs (pre-op: 6.9 ± 1.9, post-op one-year: 3.1 ± 3.4, p=0.0001, n=16), and VAS back pain (pre-op: 6.5 ± 2.8, post-op one-year: 4.3 ± 4.0, p=0.02, n=10). A single patient that underwent a multiple level, revision IC decompression experienced persistent low back pain; an arthrodesis procedure was completed within one year of IC decompression.

Conclusions: The initial results of the MIS Registry IC subgroup show a significant clinical improvement when the technique is employed to treat patients with multilevel disease or recurrent stenosis. Radiculopathy is treated with more reliable improvement than axial low back pain in these patient subgroups.