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Efficacy and Safety of Full-endoscopic Decompression via Interlaminar Approach for Central or Lateral Recess Spinal Stenosis of the Lumbar Spine

A Meta-analysis

Lee, Chang-Hyun, MD, MSc; Choi, Miyoung, MPH, PhD; Ryu, Dal Sung, MD; Choi, Il, MD§; Kim, Chi Heon, MD, PhD∗,¶,||,∗∗; Kim, Hyeun Sung, MD††; Sohn, Moon-Jun, MD, PhD‡‡,§§

doi: 10.1097/BRS.0000000000002708
LITERATURE REVIEW

Study Design. A meta-analysis of five retrospective cohort studies.

Objective. The aim of the study was to delineate the efficacy and safety of full-endoscopic decompression via the interlaminar approach for central or lateral recess spinal stenosis of the lumbar spine using a meta-analysis.

Summary of Background Data. The paradigm of spinal endoscopy is shifting from treatment of soft disc herniation to that of lumbar spinal stenosis. Technical advancements have enabled full-endoscopic decompression in spinal stenosis surgery. There is few strong evidence supporting this surgical technique, and clinicians usually rely on their own opinions and experiences.

Methods. A systematic search of electronic databases, including PubMed, EMBASE, Cochrane Library, Web of science, and KoreaMed, up to August 2017 was performed to identify studies concerning full-endoscopic decompression via the interlaminar approach for lumbar spinal stenosis. Changes in clinical outcomes [Oswestry Disability Index (ODI) and Visual Analog Scales (VAS) for back and leg pain] were compared with the minimal clinically important difference (MCID) for each item. We then calculated the mean differences and 95% confidence intervals (95% CIs) using random-effects models.

Results. We included data from five studies involving 156 patients at 6- and 12-month follow-ups. The majority of enrolled papers included patients with neurogenic claudication due to central stenosis refractory to conservative management and excluded patients with significant instability or previous surgery. The overall mean difference of patients with ODI and VAS scores for leg and back pain exceeded the criteria for MCID. ODI scores improved by 41.71 (95% CI, 39.80–43.62) after the surgery, which was twice the MCID. The VAS leg and back pain scores improved by 5.95 (95% CI, 5.70–6.21) and 4.22 (95% CI, 3.88–4.56), respectively, indicating statistically significant improvement over the MCID.

Conclusion. Successful clinical outcomes can be achieved with full-endoscopic decompression via the interlaminar approach for lumbar central spinal stenosis in patients for the defined indications.

Level of Evidence: 2

Department of Neurosurgery, Seoul National University Hospital, Seoul, the Republic of Korea

National Evidence Based Healthcare Collaborating Agency (NECA), Seoul, the Republic of Korea

Department of Neurosurgery, Inha University Hospital, College of Medicine, Inha University, Incheon, the Republic of Korea

§Department of Neurological Surgery, Dongtan Sacred Heart Hospital, University of Hallym University, Hwaseong, the Republic of Korea

Department of Neurosurgery, Seoul National University College of Medicine, Seoul, the Republic of Korea

||Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, the Republic of Korea

∗∗Clinical Research Institute, Seoul National University Hospital, Seoul, the Republic of Korea

††Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, the Republic of Korea

‡‡Department of Neurosurgery, Ilsan Paik Hospital, Inje University College of Medicine

§§Neuroscience & Radiosurgery Hybrid Research Center, Inje University College of Medicine, Goyang, the Republic of Korea.

Address correspondence and reprint requests to Chang-Hyun Lee, MD, MSc, Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea; E-mail: imspinesurgeon@gmail.com; Moon-Jun Sohn MD, PhD, Department of Neurosurgery, Inje University Ilsan Paik hospital, Neuroscience & Radiosurgery Hybrid Research Center, College of Medicine, 170, Juwharo, Ilsan Seo-gu, Goyang, Gyeonggi 10380, Republic of Korea; E-mail: mjsohn@paik.ac.kr

Received 8 January, 2018

Revised 11 April, 2018

Accepted 24 April, 2018

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

The National Research Foundation of Korea (NRF) grant funded by the Korea government (Ministry of Education) (No. 2017R1D1A3B03028470) funds were received in support of this work.

No relevant financial activities outside the submitted work.

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