Universität zu Köln

Rieger, Bernhard, Sitoci-Ficici, Kerim Hakan, Reinshagen, Clemens, Brautferger, Uta, Schackert, Gabriele, Hudak, Radovan, Zivcak, Jozef, Molcanyi, Marek and Pinzer, Thomas (2019). Endoscopic and Microscopic Segmental Decompression via Translaminar Crossover Spinal Approach in Elderly Patients. World Neurosurg., 125. S. E361 - 11. NEW YORK: ELSEVIER SCIENCE INC. ISSN 1878-8769

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Abstract

OBJECTIVE: For effective minimally invasive lumbar decompression, we changed the routine of segmental decompression. Using a high-speed drill or an ultrasound knife, we created a working channel, starting at the base of the spinous process of the upper vertebra slightly above the disc level, to target and decompress the contralateral recess, and termed it the translaminar crossover decompression (TCD). We evaluated the feasibility and compared the outcomes of a navigation-guided endoscopic translaminar crossover approach for segmental decompression (eTCD) in elderly patients with microscopic decompression using the same approach (mTCD). METHODS: A total of 740 elderly patients were enrolled in a prospective cohort study. Of the 740 patients, 297, who had undergone mTCD, and 253, who had undergone eTCD, completed a 1-year follow-up visit. In addition to the surgical data, numerical rating scales (NRSs) for back and leg pain, the Core Outcome Measures Index and Oswestry Disability Index were recorded preoperatively and 3, 6, and 12 months after surgery. The MacNab criteria were supplemented by qualitative assessment of the patients' postoperative pain-free walking distance. RESULTS: A comparison of the preoperative and postoperative clinical scores showed significant improvement after TCD in both cohorts (P < 0.01): Oswestry Disability Index, from 50.3% +/- 12.6% to 15.5% +/- 7.43%; NRS (back), from 6.9 +/- 1.9 to 2.5 +/- 1.3; NRS (leg), from 8.0 +/- 0.85 to 1.6 +/- 0.33; Core Outcome Measures Index (back), from 7.8 +/- 2.0 to 2.7 +/- 1.5. No statistically significant differences were found in the outcomes between the 2 cohorts. CONCLUSIONS: TCD inherently eliminated central stenosis and facilitated decompression of both recesses via mutual undercutting, with preservation of facet joint integrity.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Rieger, Bernhard UNSPECIFIED UNSPECIFIED UNSPECIFIED Sitoci-Ficici, Kerim Hakan UNSPECIFIED UNSPECIFIED UNSPECIFIED Reinshagen, Clemens UNSPECIFIED UNSPECIFIED UNSPECIFIED Brautferger, Uta UNSPECIFIED UNSPECIFIED UNSPECIFIED Schackert, Gabriele UNSPECIFIED UNSPECIFIED UNSPECIFIED Hudak, Radovan UNSPECIFIED UNSPECIFIED UNSPECIFIED Zivcak, Jozef UNSPECIFIED UNSPECIFIED UNSPECIFIED Molcanyi, Marek UNSPECIFIED UNSPECIFIED UNSPECIFIED Pinzer, Thomas UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-149569
DOI:	10.1016/j.wneu.2019.01.078
Journal or Publication Title:	World Neurosurg.
Volume:	125
Page Range:	S. E361 - 11
Date:	2019
Publisher:	ELSEVIER SCIENCE INC
Place of Publication:	NEW YORK
ISSN:	1878-8769
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language INTERLAMINAR APPROACH; LUMBAR; STENOSIS; SURGERY; FUTURE Multiple languages Clinical Neurology; Surgery Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/14956