Combining
the percutaneous transforaminal endoscopic decompression (PTED) with
interspinous process distraction systems (ISP) may offer additional benefits in treating spinal stenosis
in patients who have failed conservative treatment. We retrospectively
investigated the medical records of 152 patients who underwent transforaminal
endoscopic decompression with simultaneous ISP placement through the same
incision. Patients were operated on from January 2008 to June 2016 and included
80 males, and 72 patients were females. Clinical data analysis was done on 142
patients two years postoperatively since ten patients were lost in follow-up. Primary
outcome measures were pre-and postoperative visual analog scale (VAS) criteria
and the Oswestry Disability Index. Only patients with a minimum follow-up of 2
years were included. The analysis included 224 patients who underwent
interspinous spacers during the transforaminal endoscopic decompression. Of the
152 patients, 84 complained of axial facet-related pain syndromes versus the
remaining 68 patients who chiefly complained of radicular symptoms. The
postoperative VAS reduction at twoyear follow-up for the low back was 6.4. The
patient-reported ODI reductions were of a similar magnitude at 40.4%. According
to Macnab criteria, the percentage of patients who graded their surgical results
as excellent or good was 90%. At two-year follow-up, 5 percent of patients
required another operation to deal with failure to cure or recurrent symptoms
due to implant subsidence. The authors concluded that adding an interspinous
process spacer to the endoscopic decompression in patients treated for lateral
lumbar stenosis and foraminal stenosis with low-grade spondylolisthesis might improve
clinical outcomes by stabilizing the posterior column.
Keywords: Endoscopic spine surgery, Interspinous process distraction, Lumbar lateral recess and foraminal stenosis.
