General Session: Endoscopic Surgery
Presented by: K.T. Lim
(1) Good Doctor Teun Teun Spine Hospital, Anyang, Korea, Republic of
Background: The microscopic decompresIon has been a golden standard of minimally invasive surgical treatment in lumbar canal stenosis1. Meanwhile, the microendoscopic decompression (MED) has become known as more minimally invasive technique. Only a few clinical applications of an endoscopic system, whch should be the most minimally invasive, have been executed to decompress spinal stenosis. This new endoscopic system, PSLD, Percutaneous stenoscopic lumbar decompression, optimized for lumbar stenosis is fitted for a surgeon to perform laminectomy, flavectomy, foraminotomy, and discectomy and is designed to provide an easy handling during the unilateral approach and bilateral decompression as well as multi-level decompression. The system composed of 8.4mm of the working sleeve and 5.7mm of the working channel in diameter, and 12° of the field of view.
Methods: The study was retrospectively conducted in 450 consecutive cases treated with PSLD under spinal epidural anesthesia between April 1 2016 and August 31 2017. The surgical level was 483 in number and included 408 cases of 1 level operation, 33 of 2 levels and 9 of 3 levels with 1 skin incision. The patients composed of 254 males and 196 females.
Results: Postoperative MRI revealed that PSLD increased the canal volume by mean 53.7% of preoperative one at the index segment (P< 0.001), and demonstrated that damage in the normal soft tissues including muscles and th extent of removed normal bony tissues appeeared minimal. The mean improvements of VAS score and ODI were 4.0 (P< 0.001) and 40% (P< 0.001) respectively. Mean duration of operatng times was 52 minutes for bilateral decompression of 1 level and mean hospital stay was 1.2 days.
Conclusions: Decompression of spinal canal stenosis with PSLD not only improved the clinical outcomes but also increased the resultful canal volume at the index segments each significantly. The main advantages of this new technique in the current study should be a potential of uniportal multi-level procedure under local anesthesia, minimal damage of normal anatomical structures surrounding the pathology, and short hospitalization. PSLD could replace feasibbly other means including microscopic decompression in the surgical treatment of not only single level including bilateral but also two to three levels spnal stenosis in the lumbar spine.