Lumbar canal stenosis: can we treat it endoscopically?

The common treatment for lumbar canal stenosis involves an open surgical decompression with laminectomy and foraminotomy, even if spinal surgery is moving towards minimal invasiveness procedures. Minimally-invasive surgery initially and recently spinal endoscopic techniques are becoming the standard procedures for lumbar disk prolapsed in consideration of the less surgical invasiveness with a considerable reducing in the amount of normal anatomy violation, in less risk of iatrogenic postoperative instability, minimal scar tissue formation and negligible blood loss when compared to the standard open approach. These techniques also reduce the postoperative pain with consequent less need of using pain medications as well as reduced hospital stay.

From August 2016 to July 2017, we prospectively collected data on 20 patients operated on for a lumbar canal stenosis using a pure interlaminar endoscopic route. This series includes 2 unilateral and 3 bilateral L5-S1 stenosis; ten L4-L5 stenosis (8 bilateral and 2 unilateral); four L3-L4 bilateral stenosis and one bilateral L2-L3 stenosis. Among these, six were two adjacent multiple levels stenosis: L4-L5-S1 two cases; L3-L4-L5 three cases and L2-L3-L4 one case. We reviewed the demographic data as well as the pre and postoperative Visual Analogue Score and Oswestry Disability Index at 3, 6 and 12 months. We also collected the surgical complications and the result of a six-month questionnaire on patients' satisfaction.

The median operative time was 125 minutes (range between 45 and 300 minutes). Twenty-two (90%) of the patients were satisfied with the treatment received in terms of clinical results at one year follow-up. Two patients (10%) had been converted to an open procedure.

The use of the endoscopic technique for the treatment of lumbar canal stenosis seems to be correlated with good results and can be a valid alternative to the classic, more invasive, open technique.