Kai-Uwe Lewandrowski1, Álvaro Dowling2, Paulo Sérgio Teixeira de Carvalho3, André Luiz Calderaro4, Thiago Soares Dos Santos5, Marlon Sudário de Lima E Silva6, Jorge Felipe Ramírez León7, Anthony Yeung8. 1. Center for Advanced Spine Care of Southern Arizona and Surgical Institute of Tucson, Tucson, Arizona, USA and Visiting Professor, Department Neurosurgery, UNIRIO, Rio de Janeiro, Brazil. Electronic address: business@tucsonspine.com. 2. Orthopaedic Spine Surgeon, Director of Endoscopic Spine Clinic, Santiago, Chile and Visiting Professor, Department of Orthopaedic Surgery, USP, Ribeirão Preto, Brazil. 3. Department of Neurosurgery, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil. 4. Centro Ortopedico Valqueire, Departamento de Full Endoscopia da Coluna Vertebral, Rio de Janeiro, Brazil. 5. Regina Hospital, Novo Hamburgo, Rio Grande Sur, Brazil. 6. CLINCOL (Endoscopic Spine Clinic), Belo Horizonte, Minas Gerais, Brazil. 7. Fundación Universitaria Sanitas, Bogotá, D.C., Colombia; Research Team, Centro de Columna, Bogotá, Colombia; Centro de Cirugía de Mínima Invasión, CECIMIN-Clínica Reina Sofía, Bogotá, Colombia. 8. Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, New Mexico; Associate, Desert Institute for Spine Care, Phoenix, Arizona, USA.
Abstract
BACKGROUND: The indications and contraindications to the endoscopic transforaminal approach for lumbar spinal stenosis are not well defined. METHODS: We performed a Kaplan-Meier durability survival analysis of patients with the following types of spinal stenosis: type I, central canal; type II, lateral recess; type III, foraminal; and type IV, extraforaminal. The 304 patients comprised 140 men and 164 women, with an average age of 51.68 ± 15.78 years. The average follow-up was 45.3 years (range, 18-90 years). The primary clinical outcome measures were the Oswestry Disability Index, visual analog scale, and the modified Macnab criteria. RESULTS: Of 304 study patients, 70 had type I (23.0%) stenosis, 42 type II (13.7%), 151 type III (49.7%), and 41 type IV (13.5%). Excellent outcomes were obtained in 114 patients (37.5%), good in 152 (50.0%), fair in 33 (10.9%), and poor in 5 (1.6%). Kaplan-Meier durability analysis of the clinical treatment benefit with the endoscopic transforaminal decompression surgery showed statistically significance differences (P < 0.0001) on log-rank (Mantel-Cox) χ2 testing between the estimated median (50% percentile) survival times of type I (28 months), type II (53 months), type III (32 months), and type IV (66 months). CONCLUSIONS: We recommend stratifying patients based on the underlying compressive disease and the skill level of the endoscopic spine surgeon to decide preoperatively whether more difficult central or complex foraminal stenotic lesions should be considered for alternative endoscopic approaches.
BACKGROUND: The indications and contraindications to the endoscopic transforaminal approach for lumbar spinal stenosis are not well defined. METHODS: We performed a Kaplan-Meier durability survival analysis of patients with the following types of spinal stenosis: type I, central canal; type II, lateral recess; type III, foraminal; and type IV, extraforaminal. The 304 patients comprised 140 men and 164 women, with an average age of 51.68 ± 15.78 years. The average follow-up was 45.3 years (range, 18-90 years). The primary clinical outcome measures were the Oswestry Disability Index, visual analog scale, and the modified Macnab criteria. RESULTS: Of 304 study patients, 70 had type I (23.0%) stenosis, 42 type II (13.7%), 151 type III (49.7%), and 41 type IV (13.5%). Excellent outcomes were obtained in 114 patients (37.5%), good in 152 (50.0%), fair in 33 (10.9%), and poor in 5 (1.6%). Kaplan-Meier durability analysis of the clinical treatment benefit with the endoscopic transforaminal decompression surgery showed statistically significance differences (P < 0.0001) on log-rank (Mantel-Cox) χ2 testing between the estimated median (50% percentile) survival times of type I (28 months), type II (53 months), type III (32 months), and type IV (66 months). CONCLUSIONS: We recommend stratifying patients based on the underlying compressive disease and the skill level of the endoscopic spine surgeon to decide preoperatively whether more difficult central or complex foraminal stenotic lesions should be considered for alternative endoscopic approaches.
Authors: Kai-Uwe Lewandrowski; Narendran Muraleedharan; Steven Allen Eddy; Vikram Sobti; Brian D Reece; Jorge Felipe Ramírez León; Sandeep Shah Journal: Int J Spine Surg Date: 2020-11-18
Authors: Kai-Uwe Lewandrowski; Friedrich Tieber; Stefan Hellinger; Paulo Sérgio Teixeira de Carvalho; Max Rogério Freitas Ramos; Zhang Xifeng; André Luiz Calderaro; Thiago Soares Dos Santos; Jorge Felipe Ramírez León; Marlon Sudário de Lima E Silva; Girish Datar; Jin-Sung Kim; Hyeun Sung Kim; Anthony Yeung Journal: Int J Spine Surg Date: 2021-12
Authors: Kai-Uwe Lewandrowski; Albert E Telfeian; Stefan Hellinger; Max R F Ramos; Hyeun Sung Kim; Daniel W Hanson; Nimar Salari; Anthony Yeung Journal: Int J Spine Surg Date: 2021-12