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Revisional Endoscopic Foraminal Decompression via Modified Interlaminar Approach at L5-S1 after Failed Posterior Instrumented Lumbar Fusion in Elderly Patients – Lumbar Spinal Stenosis

The article discusses a new surgical technique called full-endoscopic lumbar decompression (FELD) for treating unilateral L5-S1 foraminal stenosis (FS) in elderly patients who have previously undergone posterior instrumented lumbar fusion (PILF). FELD was performed through a modified interlaminar approach under local anesthesia. The study included 11 patients who underwent FELD and were evaluated using imaging techniques and clinical assessments. The results showed that FELD effectively achieved decompression without serious complications. Patients experienced significant improvements in pain and disability scores after the surgery. At the two-year follow-up, 63.6% of patients had excellent results, and 36.4% had good results, with no need for further revision surgery. This study demonstrates the effectiveness of FELD for treating unilateral L5-S1 FS after PILF in elderly individuals

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : best recognised spine centre in London

Published article

Elderly people usually have poorer surgical tolerance and a higher incidence of complications when undergoing revision surgery after posterior instrumented lumbar fusion (PILF). Full-endoscopic transforaminal surgery is a safe and effective option, but sometimes, it is difficult to revise L5-S1 foraminal stenosis (FS) after PILF. Therefore, we developed full-endoscopic lumbar decompression (FELD) at the arthrodesis level via a modified interlaminar approach under local anesthesia. This study…

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Bioengineering (Basel). 2023 Sep 19;10(9):1097. doi: 10.3390/bioengineering10091097.ABSTRACTElderly people usually have poorer surgical tolerance and a higher incidence of complications when undergoing revision surgery after posterior instrumented lumbar fusion (PILF). Full-endoscopic transforaminal surgery is a safe and effective option, but sometimes, it is difficult to revise L5-S1 foraminal stenosis (FS) after PILF. Therefore, we developed full-endoscopic,

Bioengineering (Basel). 2023 Sep 19;10(9):1097. doi: 10.3390/bioengineering10091097.

ABSTRACT

Elderly people usually have poorer surgical tolerance and a higher incidence of complications when undergoing revision surgery after posterior instrumented lumbar fusion (PILF). Full-endoscopic transforaminal surgery is a safe and effective option, but sometimes, it is difficult to revise L5-S1 foraminal stenosis (FS) after PILF. Therefore, we developed full-endoscopic lumbar decompression (FELD) at the arthrodesis level via a modified interlaminar approach under local anesthesia. This study aimed to describe the technical note and clinical efficacy of the technique. Eleven patients with unilateral lower limb radiculopathy after PILF underwent selective nerve root block and then underwent FELD. Magnetic resonance imaging (MRI) and computer tomography (CT) were performed on the second postoperative day. Their clinical outcomes were evaluated with a Visual analog scale (VAS) of low back pain and sciatica pain, Oswestry disability index (ODI), and the MacNab score. Complete decompression was achieved in every case with FELD without serious complications. Postoperative VAS of sciatica pain and ODI at each time point and VAS of low back pain and ODI after three months postoperatively were significantly improved compared with those preoperative (p < 0.05). According to the MacNab criteria, seven patients (63.6%) had excellent results at the two-year follow-up, and four patients (36.4%) had good results. No patients required further revision surgery. FELD, via a modified interlaminar approach, is effective for treating unilateral L5-S1 FS after PILF in elderly people.

PMID:37760199 | DOI:10.3390/bioengineering10091097

The London Spine Unit : best recognised spine centre in London

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Revisional Endoscopic Foraminal Decompression via Modified Interlaminar Approach at L5-S1 after Failed Posterior Instrumented Lumbar Fusion in Elderly Patients

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Bioengineering (Basel). 2023 Sep 19;10(9):1097. doi: 10.3390/bioengineering10091097.ABSTRACTElderly people usually have poorer surgical tolerance and a higher incidence of complications when undergoing revision surgery after posterior instrumented lumbar fusion (PILF). Full-endoscopic transforaminal surgery is a safe and effective option, but sometimes, it is difficult to revise L5-S1 foraminal stenosis (FS) after PILF. Therefore, we developed full-endoscopic

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