Percutaneous Full Endoscopic Posterior Decompression for Revision of Lumbar Spinal Dynamic Stabilization

Objective: The objective of this article was to analysis the efficacy of percutaneous full endoscopic posterior decompression for revision of lumbar spinal dynamic stabilization. Methods: Twenty consecutive patients with failed lumbar spinal dynamic stabilization presenting with leg pain that had supporting imaging diagnosis of lateral stenosis and /or residual / recurrent disc herniation, or whose pain complaint was supported by relief from diagnostic and therapeutic injections, were offered percutaneous transforaminal endoscopic discectomy and foraminoplasty over a repeat open procedure. Each patient sought consultation following a transient successful, partially successful or unsuccessful open lumbar spinal dynamic stabilization surgery for disc herniation or spinal stenosis. Endoscopic foraminoplasty was also performed to either decompress the bony foramen for foraminal stenosis, or foraminoplasty to allow for endoscopic visual examination of the affected traversing and exiting nerve roots in the axilla. The average follow up time was, average 37.9 months, minimum 24 months. Outcome data at each visit included Macnab, VAS and ODI. Results: The average leg Visual Analog Scale improved from 8.9 ± 2.6 to 1.08± 0.7 (p < 0.005). Fifteen patients had excellent outcomes, four had good outcomes, one had fair outcomes, and no had poor outcomes, according to the Macnab criteria (Table 2). Nineteen of 20 patients had excellent or good outcomes, for an overall success rate of 95%. No patients required reoperation. There were no incidental durotomies, infections, vascular or visceral injuries. They were also relieved to be able to avoid "open" decompression. Conclusion: The transforaminal endoscopic approach is effective for failed lumbar spinal dynamic stabilization surgery due to residual/recurrent nucleus pulposus and lateral stenosis. Failed initial index surgery may involve failure to recognize patho-anatomy in the axilla of the foramen housing the traversing and the exiting nerve. The transforaminal endoscopic approach effectively decompresses the foramen and does not further destabilize the spine needing stabilization. It also avoids going through the previous surgical site.