Bilateral Decompressive Surgery in Lumbar Spinal Stenosis
Object: The objective of this study was to assess the feasibility and efficacy of treating spondylolisthesis-related spinal stenosis via unilateral approach bilateral decompression in which METRx-MD instrumentation is placed.
Methods: Eight consecutive patients with spinal stenosis underwent bilateral decompressions via a unilateral approach in which METRx-MD instrumentation was placed. The procedures were performed on an outpatient basis after induction of general anesthesia. The patients underwent preoperative and 3-month postoperative plain radiography in which flexion-extension x-ray films were obtained. Preoperative and postoperative magnetic resonance imaging was also performed. All radiographs and neuroimages were read by a single radiologist blinded to the clinical results.
Eight vertebral levels in the eight patients were sugically decompressed (in one patient an additional level of nonspondylolisthesis-related stenosis was decompressed). The mean operative time was 92 minutes and the mean blood loss was 33 ml/level. Preoperatively stenosis was severe in five patients, moderate/severe in two, and moderate in one; postoperatively stenosis was absent in five, mild in two, and mild/moderate in one. Motion was detected on flexion-extension radiographs in three patients, but on early (3-month) postoperative radiographs there was no evidence of progression.
Conclusions: By following the authors' procedure, minimally invasive bilateral decompression of acquired spinal stenosis associated with spondylolisthesis can be successfully performed on an outpatient basis, with reasonable operative times, minimal blood loss, and acceptable morbidity.
In 1911 Bailey and Casamajor extensively described spinal stenosis as a cause of neural compression. Surgical treatment of spinal stenosis was undertaken as early as 1900. Traditional treatment of spinal stenosis has involved wide laminectomy and undercutting of the medial facet with foraminotomy. More limited decompressive procedures including bilateral foraminotomies and unilateral approaches to bilateral decompression have been shown to be effective. Minimally invasive procedures involving chemical, mechanical, laser, and endoscopic techniques have been applied in spine surgery. Foley and Smith have popularized the microendoscopic discectomy technique for disc surgery. This technique has further evolved with the introduction of a microendoscopic tubular retractor system for microdiscectomy (METRx-MD) that improves compatibility with the operative microscope. The extension of the METRx-MD placement-related techniques to intraspinal pathological entities other than herniated discs has evolved, and surgeons are increasingly familiar and comfortable with such a technique. We implanted the METRx-MD instrumentation via a unilateral approach after performing bilateral decompression of acquired spinal stenosis in patients with Grade I degenerative spondylolisthesis.
Object: The objective of this study was to assess the feasibility and efficacy of treating spondylolisthesis-related spinal stenosis via unilateral approach bilateral decompression in which METRx-MD instrumentation is placed.
Methods: Eight consecutive patients with spinal stenosis underwent bilateral decompressions via a unilateral approach in which METRx-MD instrumentation was placed. The procedures were performed on an outpatient basis after induction of general anesthesia. The patients underwent preoperative and 3-month postoperative plain radiography in which flexion-extension x-ray films were obtained. Preoperative and postoperative magnetic resonance imaging was also performed. All radiographs and neuroimages were read by a single radiologist blinded to the clinical results.
Eight vertebral levels in the eight patients were sugically decompressed (in one patient an additional level of nonspondylolisthesis-related stenosis was decompressed). The mean operative time was 92 minutes and the mean blood loss was 33 ml/level. Preoperatively stenosis was severe in five patients, moderate/severe in two, and moderate in one; postoperatively stenosis was absent in five, mild in two, and mild/moderate in one. Motion was detected on flexion-extension radiographs in three patients, but on early (3-month) postoperative radiographs there was no evidence of progression.
Conclusions: By following the authors' procedure, minimally invasive bilateral decompression of acquired spinal stenosis associated with spondylolisthesis can be successfully performed on an outpatient basis, with reasonable operative times, minimal blood loss, and acceptable morbidity.
In 1911 Bailey and Casamajor extensively described spinal stenosis as a cause of neural compression. Surgical treatment of spinal stenosis was undertaken as early as 1900. Traditional treatment of spinal stenosis has involved wide laminectomy and undercutting of the medial facet with foraminotomy. More limited decompressive procedures including bilateral foraminotomies and unilateral approaches to bilateral decompression have been shown to be effective. Minimally invasive procedures involving chemical, mechanical, laser, and endoscopic techniques have been applied in spine surgery. Foley and Smith have popularized the microendoscopic discectomy technique for disc surgery. This technique has further evolved with the introduction of a microendoscopic tubular retractor system for microdiscectomy (METRx-MD) that improves compatibility with the operative microscope. The extension of the METRx-MD placement-related techniques to intraspinal pathological entities other than herniated discs has evolved, and surgeons are increasingly familiar and comfortable with such a technique. We implanted the METRx-MD instrumentation via a unilateral approach after performing bilateral decompression of acquired spinal stenosis in patients with Grade I degenerative spondylolisthesis.
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