Comparison of full-endoscopic and minimally invasive decompression for lumbar spinal stenosis in the setting of degenerative scoliosis and spondylolisthesis

• Published in: Neurosurgical focus Vol. 46; no. 5; p. E16
• Main Authors: Hasan, Saqib, McGrath, Lynn B, Sen, Rajeev D, Barber, Jason K, Hofstetter, Christoph P
• Format: Journal Article
• Language: English
• Published: United States 01-05-2019
• Subjects: MCID = minimally clinically important difference; LSS = lumbar spinal stenosis; scoliosis; ODI = Oswestry Disability Index; radiculopathy; LE = lumbar endoscopic; stenosis; MIS = minimally invasive surgery; PI-LL = pelvic incidence–lumbar lordosis; VAS = visual analog scale; unilateral laminotomy for bilateral decompression; ULBD = unilateral laminotomy for bilateral decompression; MIS; minimally invasive spine surgery; endoscopic spine surgery; ASA = American Society of Anesthesiologists; ULBD
• ISSN: 1092-0684; 1092-0684
• DOI: 10.3171/2019.2.FOCUS195

OBJECTIVEThe management of lumbar spinal stenosis (LSS) with concurrent scoliosis and/or spondylolisthesis remains controversial. Full-endoscopic unilateral laminotomy for bilateral decompression (ULBD) facilitates neural decompression while preserving stabilizing osseoligamentous structures and may be uniquely suited for the treatment of LSS with concurrent mild to moderate degenerative deformity. The safety and efficacy of full-endoscopic versus minimally invasive surgery (MIS) ULBD in this patient population is studied here for the first time.METHODSA retrospective analysis of prospectively collected data was conducted on 45 consecutive LSS patients with concurrent scoliosis (≥ 10° coronal Cobb angle) and/or spondylolisthesis (≥ 3 mm). Patient demographics, operative details, complications, and imaging characteristics were reviewed. Outcomes were quantified using back and leg visual analog scale (VAS) scores and the Oswestry Disability Index (ODI) at 2 weeks, 3 months, and 1 year.RESULTSA total of 26 patients underwent full-endoscopic and 19 underwent MIS-ULBD with an average follow-up period of 12 months. The endoscopic cohort experienced a significantly shorter hospital length of stay (p = 0.014) and fewer adverse events (p = 0.010). Both cohorts experienced significant improvements in VAS and ODI scores at all time points (p < 0.001), but the endoscopic cohort demonstrated significantly better early ODI scores (p = 0.024).CONCLUSIONSEndoscopic and MIS-ULBD result in similar functional outcomes for LSS with mild to moderate deformity, while the endoscopic approach demonstrates a favorable rate of complications. Further studies are required to better delineate the characteristics of spinal deformities amenable to this approach and the durability of functional results.