Joseph A Sclafani1, Kamshad Raiszadeh2, Dan Laich3, Jian Shen4, Matthew Bennett5, Robert Blok6, Kevin Liang7, Choll W Kim2. 1. Spine Institute of San Diego, San Diego, CA; Milestone Research Organization, San Diego, CA. 2. Spine Institute of San Diego, San Diego, CA. 3. Swedish Covenant Hospital, Chicago, IL. 4. Mohawk Valley Orthopedics, Amsterdam, NY. 5. Tier Orthopedic Associates, Johnson, NY. 6. Clark Memorial Medical Center, Clarksville, IN. 7. Milestone Research Organization, San Diego, CA.
Abstract
BACKGROUND: Minimally invasive transforaminal endoscopic procedures can achieve spinal decompression through either direct or indirect techniques. Subtle variations in trajectory of the surgical corridor can dictate access to the pathologic tissue. Two general strategies exist: the intradiscal "inside-out" technique and the extradiscal, intracanal (IC) technique. The IC technique utilizes a more lateral transforaminal approach than the intradiscal technique, which allows for a more direct decompression of the spinal canal. OBJECTIVE: This study is an assessment of IC patient outcome data obtained through analysis of a previously validated MIS Prospective Registry. METHODS: Post-hoc analysis was performed on the MIS Prospective Registry database containing 1032 patients. A subgroup of patients treated with the endoscopic IC technique was identified. Patient outcome measures after treatment of symptomatic disk herniation and neuroforaminal stenosis were evaluated. RESULTS: A total of 86 IC patients were analyzed. Overall, there was significant improvement in employment and walking tolerance as soon as 6 weeks post-op as well as significant one year VAS and ODI score improvement. Subanalysis of IC patients with two distinct primary diagnoses was performed. Group IC-1 (disc herniation) showed improvement in ODI and VAS back and leg outcomes at 1 year post-op. Group IC-2 (foraminal stenosis) showed VAS back and leg score improvement at one year post-op but did not demonstrate significant improvement in overall ODI outcome at any time point. The one year re-operation rate was 2% (1/40) for group IC-1 and 28% (5/18) for group IC-2. CONCLUSIONS: The initial results of the MIS Registry IC subgroup show a significant clinical improvement when the technique is employed to treat patients with lumbar disc herniation. The treatment of foraminal stenosis can lead to improved short-term clinical outcome but is associated with a high re-operation rate at 1 year post-op.
BACKGROUND: Minimally invasive transforaminal endoscopic procedures can achieve spinal decompression through either direct or indirect techniques. Subtle variations in trajectory of the surgical corridor can dictate access to the pathologic tissue. Two general strategies exist: the intradiscal "inside-out" technique and the extradiscal, intracanal (IC) technique. The IC technique utilizes a more lateral transforaminal approach than the intradiscal technique, which allows for a more direct decompression of the spinal canal. OBJECTIVE: This study is an assessment of IC patient outcome data obtained through analysis of a previously validated MIS Prospective Registry. METHODS: Post-hoc analysis was performed on the MIS Prospective Registry database containing 1032 patients. A subgroup of patients treated with the endoscopic IC technique was identified. Patient outcome measures after treatment of symptomatic disk herniation and neuroforaminal stenosis were evaluated. RESULTS: A total of 86 IC patients were analyzed. Overall, there was significant improvement in employment and walking tolerance as soon as 6 weeks post-op as well as significant one year VAS and ODI score improvement. Subanalysis of IC patients with two distinct primary diagnoses was performed. Group IC-1 (disc herniation) showed improvement in ODI and VAS back and leg outcomes at 1 year post-op. Group IC-2 (foraminal stenosis) showed VAS back and leg score improvement at one year post-op but did not demonstrate significant improvement in overall ODI outcome at any time point. The one year re-operation rate was 2% (1/40) for group IC-1 and 28% (5/18) for group IC-2. CONCLUSIONS: The initial results of the MIS Registry IC subgroup show a significant clinical improvement when the technique is employed to treat patients with lumbar disc herniation. The treatment of foraminal stenosis can lead to improved short-term clinical outcome but is associated with a high re-operation rate at 1 year post-op.
Authors: James N Weinstein; Tor D Tosteson; Jon D Lurie; Anna N A Tosteson; Brett Hanscom; Jonathan S Skinner; William A Abdu; Alan S Hilibrand; Scott D Boden; Richard A Deyo Journal: JAMA Date: 2006-11-22 Impact factor: 56.272
Authors: Harold L Asch; P Jeffrey Lewis; Douglas B Moreland; James G Egnatchik; Young J Yu; David E Clabeaux; Andrew H Hyland Journal: J Neurosurg Date: 2002-01 Impact factor: 5.115
Authors: Joseph A Sclafani; Kamshad Raiszadeh; Ramin Raiszadeh; Paul Kim; Todd Doerr; Farhan Siddiqi; Ivan LaMotta; Paul Park; Cary Templin; Sandeep Gill; Kevin Liang; Choll W Kim Journal: Int J Spine Surg Date: 2014-12-01