| 18F-048 |
Endoscopic contralateral decompression of foraminal stenosis
Seiyeon Pain Clinic, Seoul, Republic of Korea
INTRODUCTION
spinal diseases inducing low back pain are one of the most common disease that reduce individual activity and social economic activity. And the lifetime prevalence of common low back pain is estimated at 65% to 80% in developed countries. There are variable treatments from conservative managements to surgery. Endoscopic surgery has several advantages including less damage to the normal muscles and tissues, and the surgery can be done without general anesthesia.
CASE
The patient is an 72-year-old woman with a history of low back pain and radiating pain into the both buttocks and right thighs. Previously she had received multiple lumbar epidural steroid injections and other conservative therapy. But, over the past few months, symptoms on right side have worsened. The patient underwent a lumbar spine MRI, which showed a spinal stenosis at the L5S1 level and diffuse disc bulging and facet arthrosis at entire level of lumbar spine. After discussion with the patient, she elected to undergo percutaneous endoscopic lumbar decompression. Patient underwent epidural anesthesia with lidocaine 20mg. And midazolam 5mg IV was used for sedation. The patient was placed in a prone position over the Wilson frame. We used a contralateral approach of the symptomatic side to obtain the sufficient decompression without violation of either side facet joints. 2cm transverse incision was made just lateral to the outer border of the interlaminar space. After the guide wire and working cannula docked to the ipsilateral lamina under C-arm fluoroscopy, endoscope was introduced through the working channel. To expose a contralateral outer boundary of spinal canal, ipsilateral bony structures and outlayer of ligamentum flavum were removed. And we removed the contralateral outer layer, inner layer of ligamentum flavum. then, decompressed foraminal region. Procedure time took 2 hours and postoperative pain was controlled with NSAIDs. Radiating pain was decrease VAS 8 to 2 in POD 2. and maintained during 1 month.
CONCLUSION
With this approaching technique, we can decompress lumbar stenosis under visualization without violating the segmental motion unit of the spine (facet).
spinal diseases inducing low back pain are one of the most common disease that reduce individual activity and social economic activity. And the lifetime prevalence of common low back pain is estimated at 65% to 80% in developed countries. There are variable treatments from conservative managements to surgery. Endoscopic surgery has several advantages including less damage to the normal muscles and tissues, and the surgery can be done without general anesthesia.
CASE
The patient is an 72-year-old woman with a history of low back pain and radiating pain into the both buttocks and right thighs. Previously she had received multiple lumbar epidural steroid injections and other conservative therapy. But, over the past few months, symptoms on right side have worsened. The patient underwent a lumbar spine MRI, which showed a spinal stenosis at the L5S1 level and diffuse disc bulging and facet arthrosis at entire level of lumbar spine. After discussion with the patient, she elected to undergo percutaneous endoscopic lumbar decompression. Patient underwent epidural anesthesia with lidocaine 20mg. And midazolam 5mg IV was used for sedation. The patient was placed in a prone position over the Wilson frame. We used a contralateral approach of the symptomatic side to obtain the sufficient decompression without violation of either side facet joints. 2cm transverse incision was made just lateral to the outer border of the interlaminar space. After the guide wire and working cannula docked to the ipsilateral lamina under C-arm fluoroscopy, endoscope was introduced through the working channel. To expose a contralateral outer boundary of spinal canal, ipsilateral bony structures and outlayer of ligamentum flavum were removed. And we removed the contralateral outer layer, inner layer of ligamentum flavum. then, decompressed foraminal region. Procedure time took 2 hours and postoperative pain was controlled with NSAIDs. Radiating pain was decrease VAS 8 to 2 in POD 2. and maintained during 1 month.
CONCLUSION
With this approaching technique, we can decompress lumbar stenosis under visualization without violating the segmental motion unit of the spine (facet).
|
|