Extent of Decompression of Lumbar Spinal Canal after Endoscopic Surgery.
IntroductionEndoscopic techniques are being used in lumbar disk disease and lumbar canal stenosis to decompress the spinal canal. The present study analyzed pre- and postoperative magnetic resonance imaging (MRI) measurements of the lumbar canal.Material and MethodsThis was a prospective study of 30 lumbar levels. Patients < 18 years of age with unilateral compression, previous surgery at the same level, and spinal instability were excluded. Endoscopic posterior decompression was used. Pre- and postoperative MRIs of all the patients were performed. Anteroposterior (AP), transverse, interfacet diameter, canal surface area, and height and angle of the lateral recess were measured.ResultsMean ages of male and female patients were 42.1 ± 10.3 and 45.0 ± 9.9 years, respectively. Pathologies were at L4-L5, L5-S1, and L2-L3 levels in 16, 13, and 1 patient, respectively. There was significant improvement in AP diameter (4.75 ± 1.75 mm to 10.33 ± 2.11 mm), interfacet distance (12.70 ± 4.86 mm to 18.92 ± 3.53 mm), and canal surface area (76.45 ± 25.36 mm2to 187.13 ± 41.04 mm2) after decompression. Significant improvement was noted in mean height and angle of lateral recess after surgery of both sides suggesting that effective decompression of the bilateral canal was possible using a unilateral approach. Most of the patients (90%) showed excellent and good improvement after surgery. Postoperative canal surface area and AP diameter in patients who did not have any pain after surgery or had pain requiring occasional medication was higher compared with patients who continued to complain of pain and required continuous pain medication.ConclusionAlthough the number of patients was small with a short follow-up, the endoscopic technique was effective in improving AP diameter, interfacet distance, canal surface area, lateral recess height, and lateral recess angle, suggesting that an endoscopic technique using a unilateral approach is effective in bilateral decompression of neural elements.
Department of Neurosurgery, NSCB Medical College and Hospital, Jabalpur, Madhya Pradesh, India.
Naresh Kumar
NK
Dewanngan
Department of Neurosurgery, NSCB Medical College and Hospital, Jabalpur, Madhya Pradesh, India.
Yad Ram
YR
Yadav
Department of Neurosurgery, NSCB Medical College and Hospital, Jabalpur, Madhya Pradesh, India.
Vijay Singh
VS
Parihar
Department of Neurosurgery, NSCB Medical College and Hospital, Jabalpur, Madhya Pradesh, India.
Shailendra
S
Ratre
Department of Neurosurgery, NSCB Medical College and Hospital, Jabalpur, Madhya Pradesh, India.
Yatin
Y
Kher
Department of Radiology, MPMRI Center NSCB Medical College Jabalpur, Jabalpur, Madhya Pradesh, India.
Pushpraj
P
Bhatele
D000328:Adult; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D006801:Humans; D055959:Intervertebral Disc Degeneration / Q000000981:diagnostic imaging / Q000601:surgery*; 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; D011446:Prospective Studies; D013130:Spinal Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome