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European Journal of Orthopaedic Surgery & Traumatology

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01.05.2020 | Original Article

Full-endoscopic (bi-portal or uni-portal) versus microscopic lumbar decompression laminectomy in patients with spinal stenosis: systematic review and meta-analysis

verfasst von: Saran Pairuchvej, Janisa Andrea Muljadi, Jei-chen Ho, Alisara Arirachakaran, Jatupon Kongtharvonskul

Erschienen in: European Journal of Orthopaedic Surgery & Traumatology | Ausgabe 4/2020

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Abstract

Background

Lumbar stenosis causes pain in the lower lumbar spine and lower extremities and reduces the patient’s quality of life and walking ability. Thus, these conditions are common surgical indications for spinal stenosis. Previous reports have shown satisfactory clinical outcomes of the full-endoscopic (FE) and MI technique decompressive laminectomy for lumbar stenosis. However, they still remain controversial.

Objective

We conducted a systematic review and meta-analysis to compare the postoperative outcomes between FE (bi-portal or uni-portal) and MI technique decompressive laminectomy for lumbar stenosis.

Method

We searched all comparative studies that compared postoperative outcomes (operative time, VAS for back and leg pain, ODI in 3 months and last follow-up) of full-endoscopic (bi-portal or uni-portal) and microscopic technique decompressive laminectomy for lumbar stenosis from the PubMed and Scopus databases up to October 16, 2019.

Results

Nine of 1107 studies (five comparative studies and four RCT) (N = 994 patients) were eligible; all studies were included in pooling of FE and MI decompression. Five and three studies were included in pooling of bi-portal endoscopic, uni-portal endoscopic and MI decompression. All three techniques were compared in one study. Eight, nine, seven, eight, five, seven, eight and nine studies were included in pooling of VAS for back, leg, ODI in 3 months and last follow-up and operative time, respectively. The UMD of VAS for back, leg, ODI in 3 months and last follow-up of FE group was − 0.63 (95% CI − 1.15, − 0.12), − 0.15 (− 0.42, 0.11), − 2.06 (− 3.76, − 0.39), − 0.07 (− 0.22, 0.08), − 0.16 (− 0.29, − 0.03), − 0.20 (− 1.20, 0.81) scores and − 3.00 (− 12.25, 6.25) minutes when compared to MI in lumbar stenosis. In terms of complication, FE was lower risk of 0.62 (0.40, 0.96) times when compared to MI. After subgroup analysis, BESS had significant lower back and leg pain within 3 months when compared to MI group, while uni-portal FE had significant lower leg pain in the last follow-up and complication when compared to MI group. There had no difference in ODI and operative time between two groups.

Conclusion

FE had statistically significant lower back pain, lower leg pain and lower risk of having complications when compared to MI decompression in lumbar stenosis, while there is no difference in ODI and operative time between both groups. Comparing to MI, BESS had better early postoperative back pain while uni-portal FE had better leg pain and risk of having complications. Larger, prospective randomized controlled studies are needed to confirm these findings as the current literature is still insufficient.

Level of evidence

III.

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Arai Y, Hirai T, Yoshii T, Sakai K, Kato T, Enomoto M, Matsumoto R, Yamada T, Kawabata S, Shinomiya K, Okawa A (2014) A prospective comparative study of 2 minimally invasive decompression procedures for lumbar spinal canal stenosis: unilateral laminotomy for bilateral decompression (ULBD) versus muscle-preserving interlaminar decompression (MILD). Spine 39(4):332–340. https://doi.org/10.1097/brs.0000000000000136 PubMedCrossRef

Birkenmaier C, Komp M, Leu HF, Wegener B, Ruetten S (2013) The current state of endoscopic disc surgery: review of controlled studies comparing full-endoscopic procedures for disc herniations to standard procedures. Pain Phys 16(4):335–344

Choi DJ, Kim JE (2019) Efficacy of biportal endoscopic spine surgery for lumbar spinal stenosis. CiOS Clin Orthop Surg 11(1):82–88. https://doi.org/10.4055/cios.2019.11.1.82 PubMedCrossRef

Demirayak M, Sisman L, Turkmen F, Efe D, Pekince O, Goncu RG, Sever C (2015) Clinical and radiological results of microsurgical posterior lumbar interbody fusion and decompression without posterior instrumentation for lateral recess stenosis. Asian Spine J 9(5):713–720. https://doi.org/10.4184/asj.2015.9.5.713 PubMedPubMedCentralCrossRef

Deyo RA, Mirza SK, Martin BI, Kreuter W, Goodman DC, Jarvik JG (2010) Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA 303(13):1259–1265. https://doi.org/10.1001/jama.2010.338 PubMedPubMedCentralCrossRef

Dohzono S, Toyoda H, Matsumura A, Terai H, Suzuki A, Nakamura H (2017) Clinical and radiological outcomes after microscopic bilateral decompression via a unilateral approach for degenerative lumbar disease: minimum 5-year follow-up. Asian Spine J 11(2):285–293. https://doi.org/10.4184/asj.2017.11.2.285 PubMedPubMedCentralCrossRef

Duval S, Tweedie R (2000) Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 56(2):455–463PubMedCrossRef

Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315(7109):629–634PubMedPubMedCentralCrossRef

Epstein NE (2016) Commentary on: A randomized controlled trial of fusion surgery for lumbar spinal stenosis (Forsth P, Olafsson G, Carlsson T, Frost A, Borgstrom F, Fritzell P, et al. N Eng J Med 2016; 374:1414–23). Surg Neurol Int 7 (Suppl 25):S641–s643. https://doi.org/10.4103/2152-7806.191060

10.

Fujimoto T, Taniwaki T, Tahata S, Nakamura T, Mizuta H (2015) Patient outcomes for a minimally invasive approach to treat lumbar spinal canal stenosis: Is microendoscopic or microscopic decompressive laminotomy the less invasive surgery? Clin Neurol Neurosurg 131:21–25. https://doi.org/10.1016/j.clineuro.2015.01.014 PubMedCrossRef

11.

Goald HJ (1976) Microlumbar discectomy. Va Med 103(8):568–569PubMed

12.

Goald HJ (1980) Microlumbar discectomy: follow-up of 477 patients. J Microsurg 2(2):95–100PubMedCrossRef

13.

Hatta Y, Shiraishi T, Sakamoto A, Yato Y, Harada T, Mikami Y, Hase H, Kubo T (2009) Muscle-preserving interlaminar decompression for the lumbar spine: a minimally invasive new procedure for lumbar spinal canal stenosis. Spine 34(8):E276–E280. https://doi.org/10.1097/BRS.0b013e318195d943 PubMedCrossRef

14.

Heo DH, Lee DC, Park CK (2019) Comparative analysis of three types of minimally invasive decompressive surgery for lumbar central stenosis: biportal endoscopy, uniportal endoscopy, and microsurgery. Neurosurg Focus 46(5):E9. https://doi.org/10.3171/2019.2.focus197 PubMedCrossRef

15.

Heo DH, Quillo-Olvera J, Park CK (2018) Can percutaneous biportal endoscopic surgery achieve enough canal decompression for degenerative lumbar stenosis? Prospective case-control study. World Neurosurg 120:e684–e689. https://doi.org/10.1016/j.wneu.2018.08.144 PubMedCrossRef

16.

Kambin P, Casey K, O’Brien E, Zhou L (1996) Transforaminal arthroscopic decompression of lateral recess stenosis. J Neurosurg 84(3):462–467. https://doi.org/10.3171/jns.1996.84.3.0462 PubMedCrossRef

17.

Kambin P, O’Brien E, Zhou L, Schaffer JL (1998) Arthroscopic microdiscectomy and selective fragmentectomy. Clin Orthop Relat Res 347:150–167CrossRef

18.

Kambin P, Sampson S (1986) Posterolateral percutaneous suction-excision of herniated lumbar intervertebral discs. Report of interim results. Clin Orthop Relat Res 207:37–43

19.

Kambin P, Zhou L (1996) History and current status of percutaneous arthroscopic disc surgery. Spine 21(24 Suppl):57s–61s. https://doi.org/10.1097/00007632-199612151-00006 PubMedCrossRef

20.

Kang T, Park SY, Kang CH, Lee SH, Park JH, Suh SW (2019) Is biportal technique/endoscopic spinal surgery satisfactory for lumbar spinal stenosis patients? A prospective randomized comparative study. Medicine (US). https://doi.org/10.1097/md.0000000000015451 PubMedCentralCrossRef

21.

Katz JN, Harris MB (2008) Clinical practice. Lumbar spinal stenosis. N Engl J Med 358(8):818–825. https://doi.org/10.1056/nejmcp0708097 PubMedCrossRef

22.

Komp M, Hahn P, Oezdemir S, Giannakopoulos A, Heikenfeld R, Kasch R, Merk H, Godolias G, Ruetten S (2015) Bilateral spinal decompression of lumbar central stenosis with the full-endoscopic interlaminar versus microsurgical laminotomy technique: a prospective, randomized, controlled study. Pain Phys 18(1):61–70

23.

Lee CW, Yoon KJ, Ha SS (2019) Comparative analysis between three different lumbar decompression techniques (microscopic, tubular, and endoscopic) in lumbar canal and lateral recess stenosis: preliminary report. Biomed Res Int 2019:6078469. https://doi.org/10.1155/2019/6078469 PubMedPubMedCentralCrossRef

24.

Lee SH, Lee SJ, Park KH, Lee IM, Sung KH, Kim JS, Yoon SY (1996) Comparison of percutaneous manual and endoscopic laser diskectomy with chemonucleolysis and automated nucleotomy. Der Orthop 25(1):49–55

25.

Mathews HH (1996) Transforaminal endoscopic microdiscectomy. Neurosurg Clin N Am 7(1):59–63PubMedCrossRef

26.

Mayer HM, Brock M (1993) Percutaneous endoscopic discectomy: surgical technique and preliminary results compared to microsurgical discectomy. J Neurosurg 78(2):216–225. https://doi.org/10.3171/jns.1993.78.2.0216 PubMedCrossRef

27.

Min WK, Kim JE, Choi DJ, Park EJ, Heo J (2019) Clinical and radiological outcomes between biportal endoscopic decompression and microscopic decompression in lumbar spinal stenosis. J Orthop Sci. https://doi.org/10.1016/j.jos.2019.05.022 PubMedCrossRef

28.

Mobbs RJ, Li J, Sivabalan P, Raley D, Rao PJ (2014) Outcomes after decompressive laminectomy for lumbar spinal stenosis: comparison between minimally invasive unilateral laminectomy for bilateral decompression and open laminectomy: clinical article. J Neurosurg Spine 21(2):179–186. https://doi.org/10.3171/2014.4.spine13420 PubMedCrossRef

29.

Palmer TM, Peter JL, Sutton AJ, Moreno SG (2018) Contour-enhanced funnel plots for meta-analysis. STATA J 8(2):242–254CrossRef

30.

Park SM, Park J, Jang HS, Heo YW, Han H, Kim HJ, Chang BS, Lee CK, Yeom JS (2019) Biportal endoscopic versus microscopic lumbar decompressive laminectomy in patients with spinal stenosis: a randomized controlled trial. Spine J Off J N Am Spine Soc. https://doi.org/10.1016/j.spinee.2019.09.015 CrossRef

31.

Peters JL, Sutton AJ, Jones DR, Abrams KR, Rushton L (2008) Contour-enhanced meta-analysis funnel plots help distinguish publication bias from other causes of asymmetry. J Clin Epidemiol 61(10):991–996PubMedCrossRef

32.

Polikandriotis JA, Hudak EM, Perry MW (2013) Minimally invasive surgery through endoscopic laminotomy and foraminotomy for the treatment of lumbar spinal stenosis. J Orthop 10(1):13–16. https://doi.org/10.1016/j.jor.2013.01.006 PubMedPubMedCentralCrossRef

33.

Ruetten S, Komp M, Godolias G (2005) An extreme lateral access for the surgery of lumbar disc herniations inside the spinal canal using the full-endoscopic uniportal transforaminal approach-technique and prospective results of 463 patients. Spine 30(22):2570–2578. https://doi.org/10.1097/01.brs.0000186327.21435.cc PubMedCrossRef

34.

Ruetten S, Komp M, Merk H, Godolias G (2008) Full-endoscopic cervical posterior foraminotomy for the operation of lateral disc herniations using 5.9-mm endoscopes: a prospective, randomized, controlled study. Spine 33(9):940–948. https://doi.org/10.1097/brs.0b013e31816c8b67 PubMedCrossRef

35.

Ruetten S, Komp M, Merk H, Godolias G (2009) Surgical treatment for lumbar lateral recess stenosis with the full-endoscopic interlaminar approach versus conventional microsurgical technique: a prospective, randomized, controlled study—clinical article. J Neurosurg Spine 10(5):476–485. https://doi.org/10.3171/2008.7.17634 PubMedCrossRef

36.

Ruetten S, Komp U, Merk H, Godolias G (2007) A new full-endoscopic technique for cervical posterior foraminotomy in the treatment of lateral disc herniations using 6.9-mm endoscopes: prospective 2-year results of 87 patients. Minim Invasive Neurosurg 50(4):219–226. https://doi.org/10.1055/s-2007-985860 PubMedCrossRef

37.

Sairyo K, Sakai T, Higashino K, Inoue M, Yasui N, Dezawa A (2010) Complications of endoscopic lumbar decompression surgery. Minim Invasive Neurosurg MIN 53(4):175–178. https://doi.org/10.1055/s-0030-1262814 PubMedCrossRef

38.

Savitz MH (1994) Same-day microsurgical arthroscopic lateral-approach laser-assisted (SMALL) fluoroscopic discectomy. J Neurosurg 80(6):1039–1045. https://doi.org/10.3171/jns.1994.80.6.1039 PubMedCrossRef

39.

StataCorp (2015) Stata statistical software: release 14. StataCorp LP, College Station

40.

Uehara M, Takahashi J, Hashidate H, Mukaiyama K, Kuraishi S, Shimizu M, Ikegami S, Futatsugi T, Ogihara N, Hirabayashi H, Kato H (2014) Comparison of spinous process-splitting laminectomy versus conventional laminectomy for lumbar spinal stenosis. Asian Spine J 8(6):768–776. https://doi.org/10.4184/asj.2014.8.6.768 PubMedPubMedCentralCrossRef

41.

Weinstein JN, Tosteson TD, Lurie JD, Tosteson AN, Blood E, Hanscom B, Herkowitz H, Cammisa F, Albert T, Boden SD, Hilibrand A, Goldberg H, Berven S, An H (2008) Surgical versus nonsurgical therapy for lumbar spinal stenosis. N Engl J Med 358(8):794–810. https://doi.org/10.1056/NEJMoa0707136 PubMedPubMedCentralCrossRef

42.

Wong AP, Smith ZA, Lall RR, Bresnahan LE, Fessler RG (2012) The microendoscopic decompression of lumbar stenosis: a review of the current literature and clinical results. Minim Invasive Surg 2012:325095. https://doi.org/10.1155/2012/325095 PubMedPubMedCentralCrossRef

43.

Yeung AT, Tsou PM (2002) Posterolateral endoscopic excision for lumbar disc herniation: surgical technique, outcome, and complications in 307 consecutive cases. Spine 27(7):722–731. https://doi.org/10.1097/00007632-200204010-00009 PubMedCrossRef

Titel: Full-endoscopic (bi-portal or uni-portal) versus microscopic lumbar decompression laminectomy in patients with spinal stenosis: systematic review and meta-analysis
verfasst von: Saran Pairuchvej
Janisa Andrea Muljadi
Jei-chen Ho
Alisara Arirachakaran
Jatupon Kongtharvonskul
Publikationsdatum: 01.05.2020
Verlag: Springer Paris
Erschienen in: European Journal of Orthopaedic Surgery & Traumatology / Ausgabe 4/2020
Print ISSN: 1633-8065
Elektronische ISSN: 1432-1068
DOI: https://doi.org/10.1007/s00590-019-02604-2

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Full-endoscopic (bi-portal or uni-portal) versus microscopic lumbar decompression laminectomy in patients with spinal stenosis: systematic review and meta-analysis

Abstract

Background

Objective

Method

Results

Conclusion

Level of evidence

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