title: Percutaneous lumbar foraminoplasty and percutaneous endoscopic lumbar decompression for lateral recess stenosis through transforaminal approach: Technique notes and 2 years follow-up.
abstract: OBJECTIVE
  To evaluate the outcome 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 met the inclusion criteria were treated with PLF-PELD and 85 cases were followed up to 2 years postoperatively. MRI or CT checkup performed in the next morning after operation. Outcomes of symptoms were evaluated by follow-up interviews at 3 months, 6 months, 1 year and 2 years after surgery. Low back pain and leg pain were measured by Visual Analog Scale (VAS) score (1-100). Functional outcomes were assessed by using Oswestry Disability Index (ODI) and modified MacNab criteria.
  
  
  RESULTS
  Two years follow-up data were obtained from 85 cases, 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 L5S1, 1 case on bilateral L5S1, 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 46-78 years (mean age, 56.7 years), including 36 males and 49 females. 56 cases combined with HDs. Low back pain and leg pain were significantly relieved after surgery in all patients. 3 patients were complicated with dysesthesia in distribution of exiting nerve that was all operated at L5S1. Postoperative MRI/CT examination showed adequate decompression of lateral recess and removal of combined HDs in all patients. No patient had postoperative infection, dysfunctional nerve root injury or iatrogenic segmental instability. 2 cases experienced recurrence of combined HDs (2.4%), but could not undertake further revision surgery because of infirm condition. All the 85 cases were analyzed with complete follow-up data. VAS scores and ODI values were significantly lower in all time-points after surgery than before surgery. MacNab scores at 2 years after surgery were obtained from all the 85 patients. 29 cases were given "excellent"; 48 were given "good". 6 patients experienced heavier low back pain, thus being classified as "fair". 2 cases with recurrence were given "poor".
  
  
  CONCLUSIONS
  PLF-PELD with specially designed instrument is a less invasive, effective and safe surgery for lumbar lateral recess stenosis with/without combined HDs.
authors.affiliation: The Department of Orthopedic Surgery, The First Affiliated Hospital of Chinese PLA's General Hospital, People's Republic of China. Electronic address: dr_lizhenzhou@163.com.
authors.forename: Zhen-zhou
authors.initials: ZZ
authors.lastname: Li
authors.affiliation: The Department of Orthopedic Surgery, The First Affiliated Hospital of Chinese PLA's General Hospital, People's Republic of China.
authors.forename: Shu-xun
authors.initials: SX
authors.lastname: Hou
authors.affiliation: The Department of Orthopedic Surgery, The First Affiliated Hospital of Chinese PLA's General Hospital, People's Republic of China.
authors.forename: Wei-lin
authors.initials: WL
authors.lastname: Shang
authors.affiliation: The Department of Orthopedic Surgery, The First Affiliated Hospital of Chinese PLA's General Hospital, People's Republic of China.
authors.forename: Zheng
authors.initials: Z
authors.lastname: Cao
authors.affiliation: The Department of Orthopedic Surgery, The First Affiliated Hospital of Chinese PLA's General Hospital, People's Republic of China.
authors.forename: Hong-liang
authors.initials: HL
authors.lastname: Zhao
mesh_terms: D000368:Aged; D019299:Decompression, Surgical / Q000379:methods*; D017587:Diskectomy, Percutaneous / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000000981:diagnostic imaging / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D044583:Neuroendoscopy / Q000379:methods*; D013130:Spinal Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D013997:Time Factors; D014057:Tomography, X-Ray Computed
keywords: Foraminoplasty; Lumbar disk herniation; Lumbar lateral recess stenosis; Minimally invasive treatment; Percutaneous endoscopic lumbar decompression; Percutaneous endoscopic lumbar discectomy