J Orthop 2020 Sep-Oct;21:375-378. Epub 2020 Aug 7.
Less Exposure Surgery (LES) Society, Jamaica.
Background: Lower back pain is the fifth most common reason for visiting a physician in the United States. Degenerative disc disease, degenerative spondylolisthesis, arthritis, and facet arthrosis are leading causes for lumbar spinal stenosis. The previous gold standard involved open laminectomy combined with medial facetectomy and foraminotomy. The advent of minimally invasive surgery (MIS) and endoscopic technologies has led to less invasive and targeted interventions. In this study, the authors aim to show a five-year experience using a three-blade retractor for lumbar decompression and microdiscectomy.
Methods: A database review of a single spine surgeon over the last 5 years with a total of 306 patients undergoing single-level lumbar decompression with and without microdiscectomy.
Results: The average age was 47 ± 12 years and the average BMI was 29.7 ± 5.7 kg/m2 with a total of 52% male patients. Operative levels included L3-4, L4-L5, and L5-S1, with 65% of procedures at the L5-S1 level and follow-up was for two years. Overall mean VAS back scores decreased from 7.9 ± 1.6 to 2.5 ± 1.1 at two-year follow-up, p = 0.001. Preoperative ODI scores improved from 32.1 ± 5.1 to 17.9 ± 4.3 at two-year follow-up, p = 0.002. The mean EBL and surgeon time was 21 ± 15 ml and 35 ± 17 min, respectively.
Conclusion: This less exposure surgery technique can be performed to allow lumbar decompression, with or without microdiscectomy. This is an anatomy preserving technique with improved outcomes.