Percutaneous Total Endoscopic Resection of Partial Articular Processes for Treatment of Lateral Crypt Stenosis and Lumbar Spinal Stenosis: Technical Report and Efficacy Analysis

OBJECTIVE: To observe the clinical curative effect of posterior total endoscopic precision decompression for the treatment of single-segment lateral crypt lumbar spinal stenosis (LSS). METHOD: A total of 27 patients with single-segment LSS satisfying the inclusion criteria were recruited from July 2013 to September 2015. There were 18 cases of unilateral stenosis of the L(4-5) segments and 9 cases of unilateral stenosis of the L(5)-S(1) segment. All patients were treated via the posterior approach with the precise lateral crypt decompression technique. Precise decompression was performed on the narrow areas causing clinical symptoms. Clinical efficacy was assessed at 3 days, 3 months, 6 months, and 2 years after surgery. Low-back pain and sciatic nerve pain assessed by visual analog scale (VAS) score and the functional Oswestry Disability Index (ODI) were used to evaluate lumbar function, and modified MacNab score criteria were used to investigate long-term efficacy. RESULT: All patients completed the operation successfully, and the follow-up time was 2 years. The VAS score of lumbago was lower after than before surgery (preoperative: 6.96±0.90; postoperative: 2.04±1.02, P<0.05). The VAS score of sciatica was also lower after than before surgery (preoperative: 7.19±0.88, postoperative: 1.93±0.92, P<0.05), and the ODI was improved at the last follow-up (29.62±4.26) % compared with before surgery (80.07±3.98) %. The MacNab efficacy evaluation showed improvement at the end of the follow-up period: 20 cases were excellent, 6 cases were good, and 1 case was satisfactory, with a good/excellent rate of 96%. No surgical site infections, iatrogenic nerve root injuries, epidural hematomas, or other complications occurred. CONCLUSION: Total endoscopic decompression of posterior facet arthrodesis for the treatment of single-segment lateral crypt LSS has the advantages of safety, reduced recurrence and trauma, and a satisfactory curative effect. This trial is registered with ChiCTR1800015628.