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09 May 2023: Clinical Research  

Comparing Short-Term Outcomes of iLESSYS Delta System vs Bilateral Laminotomy in 80 Degenerative Lumbar Spinal Stenosis Patients: A Single-Center Study

Dongze Wu1CDE, Feifan Meng1DE, Tianzuo Chen ORCID logo1BCD, Qi Han1ADF*, Rujie Qin1ADG

DOI: 10.12659/MSM.938477

Med Sci Monit 2023; 29:e938477

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Abstract

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BACKGROUND: Degenerative lumbar spinal stenosis (DLSS) is marked by intermittent neurogenic claudication, lower back pain, and lower extremity paresthesia, affecting 11% of adults. It is traditionally treated with invasive surgery. Minimally invasive techniques, like the iLESSYS® Delta system, have emerged as alternatives. This study compares short-term patient outcomes between the iLESSYS® Delta system and conventional bilateral laminotomy in 80 DLSS patients.

MATERIAL AND METHODS: In this study, we selected 80 patients with DLSS. Forty received treatment with the iLESSYS® Delta system, while the other 40 underwent bilateral laminotomy. We monitored these patients for one year, comparing data on incision length, operation time, intraoperative blood loss, hospitalization duration, postoperative complications, visual analog scale (VAS), Oswestry Disability Index (ODI) at various time points after surgery, and Modified Macnab evaluation criteria.

RESULTS: The incision length, intraoperative blood loss, and hospitalization time were significantly better in Group A than in group B (P<0.05). However, group B had a shorter operation time with statistically significant differences (P<0.05). Both groups showed significant improvements in VAS and ODI after surgery. Group A had lower VAS and ODI scores one week after surgery (P<0.05). The excellent rate of modified MacNab criteria showed no significant difference between groups A and B (P>0.05).

CONCLUSIONS: The iLESSYS® Delta system can effectively treat DLSS and promote faster patient recovery.

Keywords: Endoscopy, Laminectomy, Minimally Invasive Surgical Procedures, Spinal Stenosis, Humans, Blood Loss, Surgical, Decompression, Surgical, Treatment Outcome, Lumbar Vertebrae, Surgical Wound, Retrospective Studies

Background

Degenerative lumbar spinal stenosis (DLSS) is characterized by neurogenic intermittent claudication, lower back pain, and lower extremity paresthesia, caused by a reduction in the effective volume of the central spinal canal, lateral recesses, or intervertebral foramen, resulting in compression of the dural sac and(/or) neurovascular structures [1]. About 11% of adults in the general population experience symptoms of DLSS, and prevalence increases with age, which is the main reason for hospitalization of spinal patients over 65 years of age [2,3]. The classic treatment for DLSS is traditional total laminectomy decompression, bilateral laminotomy decompression, unilateral laminectomy bilateral decompression, and fusion, which are only considered in cases of spinal instability [4,5]. Many studies have shown that bilateral laminectomy decompression is superior in preserving spine stability [6–10].

Nevertheless, traditional open surgery is more invasive and often leaves intractable lower back pain secondary to spinal instability, epidural scarring, and adjacent segmental degeneration after surgery [10]. Minimally invasive is a hot topic and trend in spinal surgery [11,12]. In recent years, percutaneous spinal endoscopic techniques have emerged with the interlaminar Endoscopic Surgical System iLESSYS® Delta system, which includes a wider diameter and shorter length of working cannula, which have greatly improved in terms of visualization, working space, safety, and efficiency [13–15]. Therefore, endoscopic unilateral laminotomy for bilateral decompression (Endo-ULBD), which incorporates the concepts of targeting, precision, and minimally invasive, has been applied in the treatment of DLSS with good results [15–17]. In 2020 Wu compared the clinical efficacy of microendoscopic discectomy (MED) with the iLESSYS Delta system for lumbar spinal stenosis: the latter showed precise and limited decompression, reduced short-term back pain, and promoted faster recovery [14].

As a new generation of spinal endoscopy, however, fewer studies have directly compared and described the clinical efficacy of the iLESSYS® Delta system with conventional open surgery for DLSS. Therefore, this study from a single center aimed to compare short-term patient outcomes from the iLESSYS® Delta system vs bilateral laminotomy in 80 patients with degenerative lumbar spinal stenosis.

Material and Methods

PATIENT POPULATION:

This is a prospective randomized controlled trial approved by the Ethics Committee of The First People’s Hospital of Lianyungang. This study was conducted according to the Declaration of Helsinki. Each patient signed a written informed consent form before enrollment. From September 2020 to October 2021, 80 patients with DLSS of single-segment bilateral lower-extremity symptoms enrolled in the outpatient clinic of spine surgery of the First People’s Hospital of Lianyungang according to the inclusion and exclusion criteria were studied, and the relevant clinical data were collected and recorded. Group A patients were treated with the iLESSYS® Delta system, including 24 males and 16 females; mean age 66.46±4.41 years; L4–L5 22 cases, L5–S1 18 cases; diagnostic classification according to spinal stenosis: 12 cases of central stenosis, 18 cases of peripheral stenosis, and 10 cases of hybrid stenosis; mean symptom duration: 1.35±0.31 years; hypertension 11 cases, diabetes 3 cases, old myocardial infarction 1 case. Group B patients were treated with bilateral laminotomy, including 22 males and 18 females; mean age 67.02±5.35 years; L4–L5 25 cases, L5–S1 15 cases; diagnostic typing according to spinal stenosis: central stenosis: 11 cases, peripheral stenosis 20 cases, hybrid stenosis 9 cases; mean symptom duration: 1.51±0.31 years. There were 8 cases of hypertension 8 cases, 2 cases of diabetes mellitus, 1 case of old myocardial infarction, and 1 case of previous cerebral infarction.

SURGICAL PROCEDURES:

The same group of surgeons operated on both groups using general anesthesia with tracheal intubation, prone position, silicone pads to elevate the iliac crest bilaterally so that the abdomen was hovering to reduce abdominal pressure, adjustment of the surgical bed to widen the lamina space, positioning of the responsible segment under fluoroscopy, and routine disinfection and toweling.

: Group A was treated using the iLESSYS® Delta system – Unilateral laminotomy for bilateral decompression (ULBD): the center of the intervertebral space medial to the articular eminence on the side with severe symptoms was used as the puncture point, and an incision of approximately 1 cm in length was made, the skin, subcutaneous, and lumbar dorsal fascia were incised, and a dilating tube was placed under fluoroscopy step by step to the posterior edge of the intervertebral space. The dilatation tube was introduced to the posterior edge of the intervertebral space, the working channel was introduced, the dilatation tube was withdrawn when the position was satisfactory under fluoroscopy, and the light source and camera (THE iLESSYS® Delta system with an extrascopic working sheath of 10 mm in diameter, 6.0 mm endoscopic channel and 15° endoscopic view, Joimax GmbH, Karlsruhe, Germany) were connected. The soft tissues on the surface of the vertebral plate and ligamentum flavum were removed in the Delta channel to expose the inferior margin of the upper vertebral plate, the medial aspect of the inferior articular eminence, and the ligamentum flavum. The junction of the inferior margin of the upper vertebral plate and the medial aspect of the inferior articular eminence was used as the anatomic landmark. The lower edge of the upper vertebral plate, the medial edge of the articular eminence, and the upper edge of the lower vertebral plate were removed with an endoscopy circular saw and lamina bite forceps, the interlaminar window was enlarged, and the lateral recesses were fully decompressed. The ligamentum flavum was separated and removed, and the nerve roots and dural sac were exposed. In the case of combined disc herniation, the nerve root or dural sac was retracted, the working channel was reoriented, and the herniated disc tissue was removed from the nerve root in the supra-shoulder or axillary approach to complete the ipsilateral decompression. To adjust the working channel, we removed a small amount of the spinous process root, subconsciously decompressed the contralateral lamina along the removed portion, enlarged the contralateral spinal canal, probed and decompressed the contralateral lateral recesses, separated and removed the ligamentum flavum, and completed the contralateral decompression. The nerve roots and dural sac were confirmed to be adequately decompressed under the Delta large channel. Radiofrequency bipolar electrodes were used to reach the working area through the Delta working channel to stop bleeding and ablate the nucleus pulposus. The working area was flushed with saline. The working cannula was then withdrawn, the wound was sutured, the skin was disinfected, and the wound was covered with a sterile dressing. A typical example can be seen in Figure 1.

GROUP B – BILATERAL LAMINOTOMY:

Group B patients were treated with bilateral laminotomy. The skin, subcutaneous tissue, and lumbar dorsal fascia were incised in the posterior median lumbar incision, and the paravertebral muscle tissue was peeled off to reveal both sides of the laminae and the laminae gap. The laminae were opened and decompressed with an ultrasonic bone knife or laminae biting forceps, the thickened ligamentum flavum was bitten off, the bone superfluous compressing the nerve tissue was cleared, the intervertebral disc tissue was hollowed out according to the situation, and the exit nerve roots and walking nerve roots on both sides were explored. After confirming that there was no error, we rinsed the wound, placed drainage, and closed the incision layer by layer with sutures. We disinfected the skin and covered the wound with a sterile dressing.

STATISTICAL ANALYSIS:

The data were statistically analyzed using SPSS 25.0 (IBM Corp.) software. Office 2019 (Microsoft Office, Microsoft, USA) was used to visualize the data images. Measurement data were expressed as mean±standard deviation (m±SD), and the count data were expressed as n(%). Patients’ general information, perioperative data, modified MacNab criteria, and postoperative complications were compared by chi-square test or independent samples t test, and the functional scores were compared by repeated measures analysis of variance (ANOVA). Differences were considered statistically significant at P<0.05.

Results

ANALYSIS OF THE NUMBER OF PARTICIPANTS:

Group A and B each contained 40 patients, all of whom completed the procedure. All patients received regular follow-ups through outpatient visits, telephone calls, and the Internet, and there were no dropouts. The perioperative and postoperative-related indicators were collected completely and entered into the outcome analysis.

GENERAL INFORMATION:

The general characteristics of the 2 groups of patients were not significantly different (P>0.05) and were comparable, as shown in Table 1.

PERIOPERATIVE DATA:

The incision length (1.00±0.12 cm), intraoperative blood loss (65.18±8.25 ml), and hospitalization time (5.19±1.54) days were better in group A than in group B (3.75±0.57 cm), (145.72±14.51 ml), and (7.55±0.83 days), with statistically significant differences (P<0.01); however, the operation time in group B (67.56±12.51 min) was shorter than that in group A (90.41±11.93 min), and the differences were statistically significant (P<0.01) (Table 2).

THE FUNCTIONAL SCORES:

VAS and ODI of patients in both groups at 1 week, 3 months, 6 months, and 12 months after surgery were lower than before, with P<0.05. The VAS and ODI of patients in group A were lower than those in group B at 1 week, 3 months, 6 months, and 12 months after surgery. The difference in back VAS and ODI between the 2 groups was statistically significant only 1 week after surgery, as shown in Figure 2.

MODIFIED MACNAB CRITERIA:

The outcomes of the modified MacNab criteria are shown in Figure 3 (P=0.70).

POSTOPERATIVE COMPLICATIONS:

One dural sac tear occurred in group A; no nerve root herniation was seen intraoperatively, and the patient had no significant postoperative discomfort after tight suturing and gelatin sponge wrapping. In addition, one patient had sensory paresthesia in the innervated area without muscle strength reduction, which improved after 3 days of nerve-nourishing drug treatment. Group B had 2 cases of dural sac tear, no nerve root herniation was seen, and the drainage tube was placed and wrapped by a tight suture and gelatin sponge. One of the patients had a headache after the operation, and the drainage fluid was found to be pale bloody fluid on examination. The patient’s headache gradually improved after 5 days via head-high-foot-low position, prolonged bed rest, and extubation time. In addition, 2 patients had sensory paresthesia in the innervated area, which improved with symptomatic treatment. One diabetic patient had poor postoperative incision healing, which improved with intensive dressing changes. The incidence of postoperative complications was 5% (2/40) and 12.5% (5/40) in groups A and B, respectively, with no statistically significant difference (P=0.43) (Table 3).

Discussion

LIMITATIONS:

Spinal endoscopy is limited by a long learning curve, inadequate intraoperative visualization for beginners, and incomplete decompression [14]. This study’s size and follow-up period were relatively small, and further research is needed with longer follow-up and larger samples. Moreover, this study was limited to patients with single-segment stenosis, and the results may not apply to patients with multi-segment stenosis. Finally, all procedures were performed by the same group of experienced surgeons; therefore, in the future, a multicenter study should be conducted to determine the clinical outcomes between the 2 techniques by surgeons with different skill levels.

Conclusions

The iLESSYS® Delta system, which can effectively manage DLSS through the posterior lumbar interlaminar approach, not only achieves the efficacy of bilateral laminotomy but also decompresses more precisely, quickly, and minimally invasively compared with bilateral laminotomy, with faster patient recovery. However, more prospective randomized controlled trials with large samples and long-term follow-ups are needed to validate these results.

References

1. Jensen RK, Harhangi BS, Huygen F, Koes B, Lumbar spinal stenosis: BMJ, 2021; 373; n1581

2. Jensen RK, Jensen TS, Koes B, Hartvigsen J, Prevalence of lumbar spinal stenosis in general and clinical populations: A systematic review and meta-analysis: Eur Spine J, 2020; 29(9); 2143-63

3. Ponkilainen VT, Huttunen TT, Neva MH, National trends in lumbar spine decompression and fusion surgery in Finland, 1997–2018: Acta Orthop, 2021; 92(2); 199-203

4. Lurie J, Tomkins-Lane C, Management of lumbar spinal stenosis: BMJ, 2016; 352; h6234

5. Shen J, Wang Q, Wang Y, Comparison between fusion and non-fusion surgery for lumbar spinal stenosis: A meta-analysis: Adv Ther, 2021; 38(3); 1404-14

6. Thome C, Zevgaridis D, Leheta O, Outcome after less-invasive decompression of lumbar spinal stenosis: A randomized comparison of unilateral laminotomy, bilateral laminotomy, and laminectomy: J Neurosurg Spine, 2005; 3(2); 129-41

7. Ho YH, Tu YK, Hsiao CK, Chang CH, Outcomes after minimally invasive lumbar decompression: A biomechanical comparison of unilateral and bilateral laminotomies: BMC Musculoskelet Disord, 2015; 16; 208

8. Soliman MAR, Ali A, Decompression of lumbar canal stenosis with a bilateral interlaminar versus classic laminectomy technique: A prospective randomized study: Neurosurg Focus, 2019; 46(5); E3

9. Pietrantonio A, Trungu S, Famà I, Long-term clinical outcomes after bilateral laminotomy or total laminectomy for lumbar spinal stenosis: A single-institution experience: Neurosurg Focus, 2019; 46(5); E2

10. Overdevest GM, Jacobs W, Vleggeert-Lankamp C, Effectiveness of posterior decompression techniques compared with conventional laminectomy for lumbar stenosis: Cochrane Database Syst Rev, 2015(3); CD010036

11. Zhang J, Liu TF, Shan H, Decompression using minimally invasive surgery for lumbar spinal stenosis associated with degenerative spondylolisthesis: A review: Pain Ther, 2021; 10(2); 941-959

12. Suzuki A, Nakamura H, Microendoscopic lumbar posterior decompression surgery for lumbar spinal stenosis: Literature review: Medicina (Kaunas), 2022; 58(3); 384

13. Wei FL, Du MR, Li T, Therapeutic effect of large channel endoscopic decompression in lumbar spinal stenosis: Front Surg, 2021; 8; 603589

14. Wu B, Xiong C, Tan L: Exp Ther Med, 2020; 20(6); 252

15. Han S, Zeng X, Zhu K, Clinical application of large channel endoscopic systems with full endoscopic visualization technique in lumbar central spinal stenosis: A retrospective cohort study: Pain Ther, 2022; 11(4); 1309-26

16. Komp M, Hahn P, Oezdemir S, Bilateral spinal decompression of lumbar central stenosis with the full-endoscopic interlaminar versus microsurgical laminotomy technique: A prospective, randomized, controlled study: Pain Physician, 2015; 18(1); 61-70

17. Hasan S, McGrath LB, Sen RD, Comparison of full-endoscopic and minimally invasive decompression for lumbar spinal stenosis in the setting of degenerative scoliosis and spondylolisthesis: Neurosurg Focus, 2019; 46(5); E16

18. Rudnicka E, Napierała P, Podfigurna A, The World Health Organization (WHO) approach to healthy ageing: Maturitas, 2020; 139; 6-11

19. Bussieres A, Cancelliere C, Ammendolia C, Non-surgical interventions for lumbar spinal stenosis leading to neurogenic claudication: A clinical practice guideline: J Pain, 2021; 22(9); 1015-39

20. Ammendolia C, Hofkirchner C, Plener J, Non-operative treatment for lumbar spinal stenosis with neurogenic claudication: An updated systematic review: BMJ Open, 2022; 12(1); e057724

21. Kim D, Shin JS, Moon YJ, Long-term follow-up of spinal stenosis inpatients treated with integrative Korean medicine treatment: J Clin Med, 2020; 10(1); 74

22. Kanaan T, Abusaleh R, Abuasbeh J, The efficacy of therapeutic selective nerve block in treating lumbar radiculopathy and avoiding surgery: J Pain Res, 2020; 13; 2971-78

23. Kreiner DS, Shaffer WO, Baisden JL, An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis (update): Spine J, 2013; 13(7); 734-43

24. Costa F, Innocenzi G, Guida F, Degenerative Lumbar Spine Stenosis Consensus Conference: The Italian job. Recommendations of the Spinal Section of the Italian Society of Neurosurgery: J Neurosurg Sci, 2021; 65(2); 91-100

25. Anderson DB, Luca K, Jensen RK, A critical appraisal of clinical practice guidelines for the treatment of lumbar spinal stenosis: Spine J, 2021; 21(3); 455-64

26. Weinstein JN, Tosteson TD, Lurie JD, Surgical versus nonsurgical therapy for lumbar spinal stenosis: N Engl J Med, 2008; 358(8); 794-810

27. Ahmed SI, Javed G, Bareeqa SB, Comparison of decompression alone versus decompression with fusion for stenotic lumbar spine: A systematic review and meta-analysis: Cureus, 2018; 10(8); e3135

28. Chang W, Yuwen P, Zhu Y, Effectiveness of decompression alone versus decompression plus fusion for lumbar spinal stenosis: A systematic review and meta-analysis: Arch Orthop Trauma Surg, 2017; 137(5); 637-50

29. Joelson A, Nerelius F, Holy M, Sigmundsson FG, Reoperations after decompression with or without fusion for L4–5 spinal stenosis with or without degenerative spondylolisthesis: A study of 6,532 patients in Swespine, the national Swedish spine register: Acta Orthop, 2021; 92(3); 264-68

30. Lang Z, Li JS, Yang F, Reoperation of decompression alone or decompression plus fusion surgeries for degenerative lumbar diseases: A systematic review: Eur Spine J, 2019; 28(6); 1371-85

31. Shen J, Xu S, Xu S, Fusion or not for degenerative lumbar spinal stenosis: A meta-analysis and systematic review: Pain Physician, 2018; 21(1); 1-8

32. Wu J, Zhang J, Xu T, The necessity or not of the addition of fusion to decompression for lumbar degenerative spondylolisthesis patients: A PRISMA compliant meta-analysis: Medicine (Baltimore), 2021; 100(14); e24775

33. Forsth P, Olafsson G, Carlsson T, A randomized, controlled trial of fusion surgery for lumbar spinal stenosis: N Engl J Med, 2016; 374(15); 1413-23

34. Hua W, Wang B, Ke W, Comparison of lumbar endoscopic unilateral laminotomy bilateral decompression and minimally invasive surgery transforaminal lumbar interbody fusion for one-level lumbar spinal stenosis: BMC Musculoskelet Disord, 2020; 21(1); 785

35. Tsai RY, Yang RS, Bray RS, Microscopic laminotomies for degenerative lumbar spinal stenosis: J Spinal Disord, 1998; 11(5); 389-94

36. Hua W, Wang B, Ke W, Comparison of clinical outcomes following lumbar endoscopic unilateral laminotomy bilateral decompression and minimally invasive transforaminal lumbar interbody fusion for one-level lumbar spinal stenosis with degenerative spondylolisthesis: Front Surg, 2020; 7; 596327

37. Pazarlis K, Frost A, Forsth P, Lumbar spinal stenosis with degenerative spondylolisthesis treated with decompression alone. A cohort of 346 patients at a large spine unit. Clinical outcome, complications and subsequent surgery: Spine (Phila Pa 1976), 2022; 47(6); 470-75

38. Turner JA, Ersek M, Herron L, Deyo R, Surgery for lumbar spinal stenosis. Attempted meta-analysis of the literature: Spine (Phila Pa 1976), 1992; 17(1); 1-8

39. Kleeman TJ, Hiscoe AC, Berg EE, Patient outcomes after minimally destabilizing lumbar stenosis decompression: The “Port-Hole” technique: Spine (Phila Pa 1976), 2000; 25(7); 865-70

40. den Boogert HF, Keers JC, Marinus Oterdoom DL, Kuijlen JM, Bilateral versus unilateral interlaminar approach for bilateral decompression in patients with single-level degenerative lumbar spinal stenosis: A multicenter retrospective study of 175 patients on postoperative pain, functional disability, and patient satisfaction: J Neurosurg Spine, 2015; 23(3); 326-35

41. Aizawa T, Ozawa H, Kusakabe T, Reoperation rates after fenestration for lumbar spinal canal stenosis: A 20-year period survival function method analysis: Eur Spine J, 2015; 24(2); 381-87

42. Shikong G, Haoran G, Quanyou GPercutaneous large diameter endoscopic interlaminar decompression for lumbar spinal stenosis: Chin J Min Inv Surg, 2020; 20(12) [in Chinese]

43. Lim KT, Meceda EJA, Park CK, Inside-out approach of lumbar endoscopic unilateral laminotomy for bilateral decompression: A detailed technical description, rationale and outcomes: Neurospine, 2020; 17(Suppl 1); S88-S98

44. Kim HS, Wu PH, Jang IT, Lumbar endoscopic unilateral laminotomy for bilateral decompression outside-in approach: A proctorship guideline with 12 steps of effectiveness and safety: Neurospine, 2020; 17(Suppl 1); S99-S109

45. Lv Z, Jin L, Wang K, Comparison of effects of PELD and fenestration in the treatment of geriatric lumbar lateral recess stenosis: Clin Interv Aging, 2019; 14; 2187-94

46. Zhang Y, Zhu H, Zhou Z, Comparison between percutaneous transforaminal endoscopic discectomy and fenestration in the treatment of degenerative lumbar spinal stenosis: Med Sci Monit, 2020; 26; e926631

47. Lee CW, Yoon KJ, Kim SW, Percutaneous endoscopic decompression in lumbar canal and lateral recess stenosis – the surgical learning curve: Neurospine, 2019; 16(1); 63-71

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