Surgical strategies for the decompression of lumbar spinal stenosis
have evolved to include minimally invasive techniques providing for adequate and safe decompression while reducing perioperative morbidity. Retrospective case series analysis of 220 consecutive patients with lumbar spinal stenosis
who underwent microscopic or microendoscopic minimally invasive decompression
was performed. The objective was to evaluate the risks associated with performing a minimally invasive decompression
for spinal stenosis in a large group of patients.
Two hundred twenty patients with symptomatic neurogenic claudication
from lumbar spinal stenosis
failing nonoperative treatment received a minimally invasive decompression
surgery. Intraoperative data, postoperative data through hospital discharge, and clinical follow-up were analyzed.
The average age was 74.2 years (range 49–98 years). There were 379 spinal levels decompressed in 220 patients. Sixty-nine patients (31.4%) had a grade 1 degenerative spondylolisthesis. One hundred sixty-eight patients (76%) received spinal anesthesia, and 52 received general anesthesia. Eighty-seven patients (40%) had a preoperative American Society of Anesthesiologists score of 3 or 4. Average operative blood loss was 92 mL. There were 17 intraoperative durotomies (4.5% rate). The average length of stay before discharge was 1.2 days. Ten patients went to inpatient rehabilitation at discharge. One hundred ninety-four patients (88.2%) were discharged within 24 hours. There were five readmissions within the first month after discharge, four of those for medical complications. There were 24 minor complications and 14 major complications. Forty-two patients (19%) took no oral or parenteral narcotic pain medications in the postanesthesia to discharge period.
Conclusion Minimally invasive decompression
strategies for spinal stenosis seem consistently to result in short hospital lengths of stay, minimal requirements for narcotic pain medications, and a low rate of readmission and complications.