Usefulness of Minimally Invasive Posterior Foraminotomy using Tubular Retractor for Lumbar Spinal Stenosis with Foraminal Stenosis

Hun-Kyu Shin; Jae-Yeol Choi; Hwa-Jae Jeong; Eugene Kim; Se-Jin Park; Seung-Hee Lee; Dong-seok, Seo

doi:10.4184/jkss.2014.21.1.15

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Shin, Choi, Jeong, Kim, Park, Lee, and Seo: Usefulness of Minimally Invasive Posterior Foraminotomy using Tubular Retractor for Lumbar Spinal Stenosis with Foraminal Stenosis

Original Article

Journal of Korean Spine Surg 2014;21(1):15-23.

Published online: 21 March 2014

DOI: https://doi.org/10.4184/jkss.2014.21.1.15

Usefulness of Minimally Invasive Posterior Foraminotomy using Tubular Retractor for Lumbar Spinal Stenosis with Foraminal Stenosis

Hun-Kyu Shin, M.D., Jae-Yeol Choi, M.D., Hwa-Jae Jeong, M.D., Eugene Kim, M.D., Se-Jin Park, M.D., Seung-Hee Lee, M.D., Dong-seok, Seo, M.D.

Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea

Corresponding author: Jae-Yeol Choi, M.D., 108, Pyeong-dong, Jongno-gu, Seoul, Korea, Kangbuk Samsung Hospital TEL: 82-2-2001-2168, FAX: 82-2-2001-2176 E-mail: ch5420.choi@samsung.com

Received 31 May 2012 Revised 12 October 2012 Accepted 8 November 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

Retrospective study.

Objectives

The aim of this study was to report the usefulness of lumbar posterior foraminotomy and central decompression using tubular retractor with minimally invasive technique.

Summary of Literature Review

Posterior decompression and arthrodesis for the treatment of lumbar spinal stenosis with foraminal stenosis is a classical surgical method. It is inappropriate for patients who have rejection to arthrodesis or medical problems, because it may have several complications.

Materials and Methods

Clinical results were obtained from 12 patients who underwent posterior foraminotomy and central decompression from January 2009 to April 2011 and were assessed using a Visual analogue scale, Oswestry disability index and the Prolo outcome scale.

Results

Six Of 12 patients showed immediate relief of radiculopathy. Postoperative posterior lumbar pain and spasm were negligible, and no surgically related complication was noted. During the followup period, the Oswestry disability index decreased from 24.25±2.89(pre-op) to 19.33±3.02(Last F/U)(p=0.28, paired t-test) in 8 of 12 patients.

Conclusions

A minimally invasive posterior foraminotomy and central decompression could be an alternative surgical option for the treatment of lumbar spinal stenosis with foraminal stenosis, especially in subjects with old age, having medical problems and refusal of arthrodesis.

Keywords: Lumbar spine, Spinal stenosis, Foraminotomy, Minimally invasive surgery

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Figures and Tables%

Fig. 1.

Imaging studies is obtained in a 56-year-old woman who presented with severe back & radicular pain on left lower extremity. Preoperative sagittal (A) and axial (B) T2 weighted MR image demonstrates a left L5-S1 foraminal stenosis (arrow).

Fig. 2.

Postoperative image is obtained in Case 2. (A, B) Axial CT images show laminoforaminotomy site. (C) 3D-CT images depicteforaminotomy site.

Fig. 3.

Radiographic studies. (A) Preoperative anteroposterior plain radiograph is obtained in a 73-year-old man with a left-sided L5 radiculopathy and an L5-S1 extraforaminal stenosis. A large accessory process and laterally projecting osteophytes are present. (B) Postoperative radiograph demonstrate that the osseous boundary of the extraforaminal exit is decompressed. Note the changes (arrow heads) in the respective pedicle and trasverse processes on the left side of L5.

Table 1.

Prolo Functional Economic Outcome Scale

Score	Criteria
Economic status
1	Complete disability
2	No gainful occupation but can do housework or some retirement activities
3	Able to work, but not as previous occupation
4	Able to work at previous occupation but w/ restrictions or limited status
5	Able to perform previous occupation w/o restrictions
Functional status
1	Total incapacity (worse than before operation)
2	Mild to moderate level of low-back pain &/or sciatica (able to perform tasks of daily living)
3	Low level of pain & able to do everything except sports
4	No pain, but has had >1 recurrence of low-back pain or sciatica
5	Complete recovery w/o recurrent pain, no activity restriction

Table 2.

Baseline Characteristics of Study Subjects

Case No.	Sex/Age	Underlying disease	Side	Level	Duration (month)	F/U(month)
1	F/62	Cerebral infarct Angina	Lt.	L4-S1	5	22
2	M/73	HTN^＊ ASO^†	Lt.	L4-S1	120	11
3	F/83	HTN	Rt.	L4-S1	24	34
4	F/56	HTN	Lt.	L3-S1	6	10
5	F/79	HTN	Both	L4-L5	36	14
6	F/56	HTN	Lt.	L4-S1	8	15
7	M/76	HTN DM^‡	Lt.	L4-S1	7	10
8	M/48	(-)	Rt.	L4-S1	120	27
9	M/58	HTN	Rt.	L4-L5	5	11
10	F/67	HTN DM	Rt.	L1-S1	6	15
11	M/41	(-)	Lt.	L4-L5	5	13
12	F/76	(-)	Lt.	L4-S1	9	11

^＊ HTN; hypertension,

^† ASO; artherosclerosis,

^‡ DM; diabetes mellitus.

Table 3.

Change of Clinical Course using VAS, ODI, POS

Case No.	VAS^＊ score		ODI^†(%)		POS^‡
Case No.	pre-op	last f/u	pre-op	last f/u	pre-op	last f/u
1	9	6	29	23	2	3
2	7	5	23	20	5	7
3	8	8	20	20	6	6
4	6	8	21	14	5	7
5	3	6	28	36	4	2
6	9	2	39	19	3	7
7	6	4	20	14	7	8
8	7	3	17	1	6	10
9	10	6	45	15	2	7
10	8	9	7	33	8	2
11	8	3	21	6	4	7
12	8	3	21	31	7	4

^＊ VAS; visual analogue scale

^† ODI; oswestry disability index

^‡ POS; prolo outcome scale

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