title: Early experience with endoscopic foraminotomy in patients with moderate degenerative deformity.
abstract: OBJECTIVE Asymmetrical degeneration of the disc is one of the most common causes of primary degenerative scoliosis in adults. Coronal deformity is usually less symptomatic than a sagittal deformity because there is less expenditure of energy and hence less effort to maintain upright posture. However, nerve root compression at the fractional curve or at the concave side of the main curve can give rise to debilitating radiculopathy. METHODS This study was a retrospective analysis of 16 patients with coronal deformity of between 10° and 20°. All patients underwent endoscopic foraminal decompression surgery. The pre- and postoperative Cobb angle, visual analog scale (VAS), 36-Item Short Form Health Survey (SF-36), and Oswestry Disability Index scores were measured. RESULTS The average age of the patients was 70.0 ± 15.5 years (mean ± SD, range 61-86 years), with a mean followup of 7.5 ± 5.3 months (range 2-14 months). The average coronal deformity was 16.8° ± 4.7° (range 10°-41°). In 8 patients the symptomatic foraminal stenosis was at the level of the fractional curve, and in the remaining patients it was at the concave side of the main curve. One of the patients included in the current cohort had to undergo a repeat operation within 1 week for another disc herniation at the adjacent level. One patient had CSF leakage, which was repaired intraoperatively, and no further complications were noted. On average, preoperative VAS and SF-36 scores showed a tendency for improvement, whereas a dramatic reduction of VAS, by 65% (p = 0.003), was observed in radicular leg pain. CONCLUSIONS Patients with mild to moderate spinal deformity are often compensated and have tolerable levels of back pain. However, unilateral radicular pain resulting from foraminal stenosis can be debilitating. In select cases, an endoscopic discectomy or foraminotomy enables the surgeon to decompress the symptomatic foramen with preservation of essential biomechanical structures, delaying the need for a major deformity correction surgery.
authors.affiliation: Department of Neurological Surgery and The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Karthik
authors.initials: K
authors.lastname: Madhavan
authors.affiliation: Department of Neurological Surgery and The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Lee Onn
authors.initials: LO
authors.lastname: Chieng
authors.affiliation: Department of Neurological Surgery, University of Washington, Seattle, Washington; and.
authors.forename: Lynn
authors.initials: L
authors.lastname: McGrath
authors.affiliation: Department of Neurological Surgery, University of Washington, Seattle, Washington; and.
authors.forename: Christoph P
authors.initials: CP
authors.lastname: Hofstetter
authors.affiliation: Department of Neurological Surgery and The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida.
authors.forename: Michael Y
authors.initials: MY
authors.lastname: Wang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual / Q000706:statistics & numerical data; D004185:Disability Evaluation; D004724:Endoscopy / Q000379:methods*; D005260:Female; D059526:Foraminotomy / Q000379:methods*; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D016896:Treatment Outcome; D064232:Visual Analog Scale
keywords: LL = lumbar lordosis; MCS = mental component summary; ODI = Oswestry Disability Index; PCS = physical component summary; PI = pelvic incidence; PT = pelvic tilt; SF-36 = 36-Item Short Form Health Survey; SVA = sagittal vertical axis; VAS = visual analog scale; coronal deformity; endoscopic spine surgery; scoliosis