Percutaneous lumbar foraminoplasty and percutaneous endoscopic lumbar decompression for lateral recess stenosis through transforaminal approach：technique notes and 2 years’ follow-up
LI Zhen-zhou
HOU Shu-xun
SHANG Wei-lin
CAO Zheng
ZHAO Hong-liang
SONG Ke-ran
Abstract：Objective To evaluate the outcomes and safety of percutaneous lumbar foraminoplasty ( PLF ) and percutaneous endoscopic lumbar decompression ( PELD ) with specially designed instrument for lumbar lateral recess stenosis with / without herniated discs ( HDs ).Methods From August of 2011 to August of 2013, 96 patients meeting the inclusion criteria were treated with PLF-PELD and 85 cases were followed up to 2 years postoperatively, including 14 cases on unilateral L3-4, 1 case on bilateral L3-4, 49 cases on unilateral L4-5, 3 cases on bilateral L4-5, 12 cases on unilateral L5 - S1, 1 case on bilateral L5 - S1, 3 cases on unilateral L3-5 and 2 cases on unilateral L4 - S1. So totally 95 lumbar lateral recesses were decompressed. Patients ranged in age from 46 to 78 years ( mean: 56.7 years ), including 36 males and 49 females. Fifty-six cases combined with HDs including 42 cases of prolapse type and 14 cases of sequestration type. MRI or CT checkup were performed in the next morning after the operation. Outcomes were evaluated by follow-up interviews at 3 months, 6 months, 1 year and 2 years after the surgery. Low back pain and leg pain were measured by Visual Analog Scale ( VAS ) score ( 1 - 100 ). Functional outcomes were assessed by Oswestry Disability Index ( ODI ) and modiifed MacNab criteria.Results Pre-operative symptoms and deifcits included nerve root dermatome hypoesthesia in 56 patients ( 65.9% ), nerve root myotome muscle weakness in 25 patients ( 29.4% ), and weakening or disappearance of tendon relfex in 14 patients ( 16.5% ). Low back pain and leg pain were signiifcantly relieved after the surgery in all patients. Three patients were complicated with dysesthesia in the distribution of exiting nerve that was all operated at L5 - S1. Complains were reduced after 1 - 2 week’s treatment with medium frequency pulse electrotherapy. Postoperative MRI / CT examination showed adequate decompression of the lateral recess and removal of combined HDs in all patients. No patients had postoperative infection, dysfunctional nerve root injury or iatrogenic segmental instability. Two cases experienced the recurrence of combined HDs ( 2.4% ), but couldn’t undertake further revision surgery because of inifrm condition. All the 85 cases were analyzed with complete follow-up data. VAS scores and ODI values were signiifcantly lower in all time-points after the surgery. MacNab scores at 2 years after the surgery were obtained from all the 85 patients. Twenty-nine cases were given “excellent”; 48 were given “good”. Six patients experienced heavier low back pain, thus being classiifed as “fair”. Two cases with recurrence were given “poor”. Sensation and muscle strength of involved nerve roots recovered significantly (P < 0.01 ) at 2 years’ follow-up, while tendon reflex was not changed (P = 0.832 ).Conclusions PLF-PELD with specially designed instrument is a less invasive, effective and safe surgery for lumbar lateral recess stenosis with / without combined HDs.
Keywords：Surgical proceduresminimally invasiveLumbar vertebraeIntervertebral disc displacementDecompressionsurgicalDiskectomypercutaneous
Publication Date：2016-01-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：6( 333-338 )