J Korean Soc Spine Surg.  2014 Mar;21(1):15-23. 10.4184/jkss.2014.21.1.15.

Usefulness of Minimally Invasive Posterior Foraminotomy using Tubular Retractor for Lumbar Spinal Stenosis with Foraminal Stenosis

• Shin HK
• Choi JY
• Jeong HJ
• Kim E
• Park SJ
• Lee SH
• Seo DS

• KMID: 1840412
• DOI: http://doi.org/10.4184/jkss.2014.21.1.15

Abstract

STUDY DESIGN: Retrospective study.
OBJECTIVES
The aim of this study was to report the usefulness of lumbar posterior foraminotomy and central decompression using tubular retractor with minimally invasive technique. SUMMARY OF LITERATURE REVIEW: Posterior decompression and arthrodesis for the treatment of lumbar spinal stenosis with foraminal stenosis is a classical surgical method. It is inappropriate for patients who have rejection to arthrodesis or medical problems, because it may have several complications.
MATERIALS AND METHODS
Clinical results were obtained from 12 patients who underwent posterior foraminotomy and central decompression from January 2009 to April 2011 and were assessed using a Visual analogue scale, Oswestry disability index and the Prolo outcome scale.
RESULTS
Six Of 12 patients showed immediate relief of radiculopathy. Postoperative posterior lumbar pain and spasm were negligible, and no surgically related complication was noted. During the follow-up period, the Oswestry disability index decreased from 24.25+/-2.89(pre-op) to 19.33+/-3.02(Last F/U)(p=0.28, paired t-test) in 8 of 12 patients.
CONCLUSIONS
A minimally invasive posterior foraminotomy and central decompression could be an alternative surgical option for the treatment of lumbar spinal stenosis with foraminal stenosis, especially in subjects with old age, having medical problems and refusal of arthrodesis.

Keyword

Lumbar spine; Spinal stenosis; Foraminotomy; Minimally invasive surgery

MeSH Terms

Arthrodesis
Constriction, Pathologic*
Decompression
Disulfiram
Follow-Up Studies
Foraminotomy*
Humans
Radiculopathy
Retrospective Studies
Spasm
Spinal Stenosis*
Surgical Procedures, Minimally Invasive
Disulfiram

Figure

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  Fig. 1. Imaging studies is obtained in a 56-year-old woman who presented with severe back & radicular pain on left lower extremity. Preoperative sagittal (A) and axial (B) T2 weighted MR image demonstrates a left L5-S1 foraminal stenosis (arrow).

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  Fig. 2. Postoperative image is obtained in Case 2. (A, B) Axial CT images show laminoforaminotomy site. (C) 3D-CT images depicteforaminotomy site.

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  Fig. 3. Radiographic studies. (A) Preoperative anteroposterior plain radiograph is obtained in a 73-year-old man with a left-sided L5 radiculopathy and an L5-S1 extraforaminal stenosis. A large accessory process and laterally projecting osteophytes are present. (B) Postoperative radiograph demonstrate that the osseous boundary of the extraforaminal exit is decompressed. Note the changes (arrow heads) in the respective pedicle and trasverse processes on the left side of L5.

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