Abstract

Introduction:According to current knowledge, decompression reduces symptoms of neurogenic claudication and neurological deficits in lumbar spinal canal stenosis The extent of decompression and concurrent fusion are still controversial. The aim is sufficient decompression with reduced traumatization and destabilization. The goal of this prospective study was to compare initial results of the full-endoscopic (Group 1) to microsurgical (Group 2) decompression in degenerative lumbar recessus stenosis.Material and Methods:60 patients were operated in full-endoscopic lateral transforaminal (6 pats.) and interlaminar (24 pats.) or known conventional microsurgical (39 pats.) technique in 2004/2005. Inclusion criteria were: monosegmental unilateral recessus stenosis, no central stenosis, no disc prolapse, no pronounced instabilities or deformities, one-sided neurogenic claudication, back pain max. 10/100 VAS, positive nerve blockade. The full-endoscopic operation was performed with 6.8-mm endoscopes with 4.2-mm intra-endoscopic working canal under continuous lavage. There were specific inclusion criteria for the lateral transforaminal or interlaminar access. The follow-up period was 18 months. 55 patients (92 %) were followed. Validated measuring instruments were used in addition to general parameters.Results:Intraoperative complications did not occur in any patient. One patient in Group 1 and 2 patients in Group 2 showed transient dysesthesia. The mean operation time in Group 1 was 42 minutes, in Group 2, 54 minutes. There was no measurable blood loss in Group 1, and a mean blood loss of 35 mL in Group 2. The maximum time in hospital in Group 1 was 4 days, and 6 days in Group 2. The postoperative pain symptoms as well as rehabilitation were significantly reduced in Group 1. The results revealed no or only occasional leg pain in 51 patients, 4 patients reported unsatisfactory results. The same was observed in lengthening of the walking distance. Radiological examination showed no increase in instability. The measuring instruments showed a significant, constant improvement on average. There were no significant differences between the two groups or within Group 1 between the two access pathways. Conclusion:Within the indication criteria, the full-endoscopic operation of degenerative recessus stenosis is technically feasible and a potential alternative to the conventional procedure. It enables a selective approach with direct visualization, decompression is found to be sufficient and practically complication-free, the traumatization of the access pathway and the spinal canal structures is reduced. The questions of recurrence and stability cannot yet be definitively answered.