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Outcome Measures of an Intracanal, Endoscopic Transforaminal Decompression Technique: Initial Findings from the MIS Prospective Registry

Joseph A. Sclafani, MD,1,2 Kamshad Raiszadeh, MD,1 Dan Laich, DO,3 Jian Shen, MD, PhD,4 Matthew Bennett, MD,5 Robert Blok, DO,6 Kevin Liang, PhD,2 Choll W. Kim, MD, PhD1

1Spine Institute of San Diego, San Diego, CA, 2Milestone Research Organization, San Diego, CA, 3Swedish Covenant Hospital, Chicago, IL, 4Mohawk Valley Orthopedics, Amsterdam, NY, 5Tier Orthopedic Associates, Johnson, NY, 6Clark Memorial Medical Center, Clarksville, IN

Abstract

Background

Minimally invasive transforaminal endoscopic procedures can achieve spinal decompression through either direct or indirect techniques. Subtle variations in trajectory of the surgical corridor can dictate access to the pathologic tissue. Two general strategies exist: the intradiscal "inside-out" technique and the extradiscal, intracanal (IC) technique. The IC technique utilizes a more lateral transforaminal approach than the intradiscal technique, which allows for a more direct decompression of the spinal canal.

Objective

This study is an assessment of IC patient outcome data obtained through analysis of a previously validated MIS Prospective Registry.

Methods

Post-hoc analysis was performed on the MIS Prospective Registry database containing 1032 patients. A subgroup of patients treated with the endoscopic IC technique was identified. Patient outcome measures after treatment of symptomatic disk herniation and neuroforaminal stenosis were evaluated.

Results

A total of 86 IC patients were analyzed. Overall, there was significant improvement in employment and walking tolerance as soon as 6 weeks post-op as well as significant one year VAS and ODI score improvement. Subanalysis of IC patients with two distinct primary diagnoses was performed. Group IC-1 (disc herniation) showed improvement in ODI and VAS back and leg outcomes at 1 year post-op. Group IC-2 (foraminal stenosis) showed VAS back and leg score improvement at one year post-op but did not demonstrate significant improvement in overall ODI outcome at any time point. The one year re-operation rate was 2% (1/40) for group IC-1 and 28% (5/18) for group IC-2.

Conclusions

The initial results of the MIS Registry IC subgroup show a significant clinical improvement when the technique is employed to treat patients with lumbar disc herniation. The treatment of foraminal stenosis can lead to improved short-term clinical outcome but is associated with a high re-operation rate at 1 year post-op.

keywords: 
minimally invasive spine surgery, Endoscopic Decompression, Stenosis, Disc Herniation, clinical outcome
Volume 9 Article 69
doi: 
10.14444/2069