• World Neurosurg · Jan 2021

    Indication And Contraindication Of Endoscopic Transforaminal Lumbar Decompression.

    • Kai-Uwe Lewandrowski, Álvaro Dowling, Paulo Sérgio Teixeira de Carvalho, André Luiz Calderaro, Thiago Soares Dos Santos, Marlon Sudário de Lima E Silva, León Jorge Felipe Ramírez JFR Fundación Universitaria Sanitas, Bogotá, D.C., Colombia; Research Team, Centro de Columna, Bogotá, Colombia; Centro de Cirugía de Mínima Inv, and Anthony Yeung.
    • 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.
    • World Neurosurg. 2021 Jan 1; 145: 631-642.

    BackgroundThe indications and contraindications to the endoscopic transforaminal approach for lumbar spinal stenosis are not well defined.MethodsWe 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.ResultsOf 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).ConclusionsWe 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.Copyright © 2020. Published by Elsevier Inc.

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