Treatment of lumbar spinal stenosis by full-endoscopic trephination-based bilateral decompression via a unilateral approach

Objective To investigate the feasibility and efficacy of full-endoscopic trephination-based bilateral decompression via a unilateral approach in the treatment of lumbar spinal stenosis (LSS). Methods From September 2015 to September 2017, 31 cases of LSS were treated by full-endoscopic trephination-based bilateral decompression via a unilateral approach. The operative time, intraoperative blood loss, postoperative complications, and CT reexamination findings were recorded, the efficacy was evaluated according to the Nakai standard at the last follow-up, and the excellent/good result rate was calculated. Results The operation time ranged from 65 to 125 min, with an average of (48±13) min. Intraoperative blood loss ranged from 25 to 180 ml, with an average of (37±9) ml. The incision length was about 7-8 mm, with an average of (7.0±0.6) mm. All the operations were successfully completed without complications such as nerve injury, postoperative infection, and lumbar instability. Postoperative CT showed adequate decompression of the spinal canal. The patients were followed for 6 to 18 months, with an average period of (10.0±4.6) months. With regard to curative effects, excellent, good, fair, and poor results were achieved in 22, 6, 2, and 1 case, respectively, with an excellent/good result rate of 90.3% (28/31). Conclusion Full-endoscopic trephination-based bilateral decompression via a unilateral approach in the treatment of LSS is associated with adequate decompression, small trauma, quick recovery, low cost, high safety, and low incidence of postoperative complications, and can minimize damage to the lumbar spinal structure, representing an ideal minimally invasive procedure for the treatment of LSS. Key words: Spinal stenosis; Spine endoscopy; Trephination