title: Microendoscopy-assisted muscle-preserving interlaminar decompression for lumbar spinal stenosis: clinical results of consecutive 105 cases with more than 3-year follow-up.
abstract: METHODS
  A retrospective review of data collected prospectively on patients who underwent microendoscopy-assisted muscle-preserving interlaminar decompression (MILD) for lumbar spinal stenosis.
  
  
  OBJECTIVE
  To evaluate the clinical results including surgical invasiveness and reduction rate of facet joint with a follow-up of more than 3 years.
  
  
  BACKGROUND
  Hatta et al reported microscopic posterior decompression procedure, MILD for lumbar spinal stenosis with reference to the cervical central approach put forth by Shiraishi. Mikami et al applied spinal microendoscopy to MILD procedure (microendoscopy-assisted MILD).
  
  
  METHODS
  One hundred five consecutive patients, who underwent microendoscopy-assisted MILD, participated in this study. Operative time, blood loss, visual analogue scale (VAS), serum creatine kinase and C-reactive protein, surgical complications, reduction rate of the facet joint, Japanese Orthopaedic Association score, and Short-Form 36 were evaluated.
  
  
  RESULTS
  The operative time was 99.3 minutes and the intraoperative bleeding was 15.7 mL on average. The mean VAS score to assess surgical site pain was 20.6 mm on postoperative day 1. The mean serum creatine kinase on postoperative day 1 and C-reactive protein on postoperative day 3 were 145.4 IU/L and 2.7 mg/dL, respectively. Surgical complications were identified in 2 cases, cauda equina injury and dural tear. The mean reduction rate of the facet joint was 3%. The follow-up rate was 83.3% and the mean follow-up period was 52.7 months. The Japanese Orthopaedic Association score improved significantly from 14.8 to 23.7 points on average. Significant improvements in Short-Form 36 were observed in all subscales except in General Health. Revision surgical procedures were performed in 8 cases at the operated level including 4 of juxtafacet cyst, 3 of disc herniation, and 1 of insufficient decompression.
  
  
  CONCLUSIONS
  Microendoscopy-assisted MILD is a minimally invasive procedure and favorable clinical results can be expected for lumbar spinal stenosis.
  
  
  METHODS
  4.
authors.affiliation: From the Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan.
authors.forename: Mitsunori
authors.initials: M
authors.lastname: Yoshimoto
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Miyakawa
authors.forename: Tsuneo
authors.initials: T
authors.lastname: Takebayashi
authors.forename: Kazunori
authors.initials: K
authors.lastname: Ida
authors.forename: Katsumasa
authors.initials: K
authors.lastname: Tanimoto
authors.forename: Shuji
authors.initials: S
authors.lastname: Kawamura
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Yamashita
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000378:metabolism; D003402:Creatine Kinase / Q000097:blood; D019299:Decompression, Surgical / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013130:Spinal Stenosis / Q000097:blood / Q000601:surgery*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D002097:C-Reactive Protein; D003402:Creatine Kinase