The short-term effectiveness of precise safety decompression via two-time percutaneous lumbar foraminoplasty (TPLF) and percutaneous endoscopic lumbar decompression (PELD) for lumbar lateral spinal canal (LLSC) stenosis

Purpose This prospective study reports a new technique: precise safety decompression via two-time percutaneous lumbar foraminoplasty (TPLF) and percutaneous endoscopic lumbar decompression (PELD) for lumbar lateral spinal canal (LLSC) stenosis, and short-term clinical outcomes.Methods 69 patients with single-level LLSC stenosis simultaneously occurred in both zone 1 and 2 who underwent TPLF-PELD from November 2018 to April 2019 were prospectively analyzed. Clinical outcomes were evaluated according to preoperative, 3 months postoperatively and last follow-up via leg pain/low back pain (LBP) visual analogue scale (VAS) scores, Oswestry disability index (ODI) scores and the Macnab criteria. The postoperative MRI and CT were used to confirm the complete decompression and flexion-extension X-Ray in last follow-up were used to observe lumbar stability.Results All patients successfully underwent TPLF-PELD and the stenosis was completely decompressed confirmed by post-operative MRI and CT. The mean follow-up duration was 13 months (range, 8-17 months). The mean preoperative leg pain VAS score is 7.05±1.04 (range 5-9), which decreased to 1.03±0.79(range 0-3) at third month postoperatively and to 0.75±0.63 (range 0-2) by the last follow-up visit. The mean preoperative ODI was 69.8±9.05 (range, 52-85), which decreased to 20.3±5.52 (range, 10-35) at the third month postoperatively and to 19.6±5.21 (range, 10-34) by the last follow-up visit. The satisfactory (excellent or good) results were 94.2%. There was 1 patients with aggravated symptoms which relieved after open surgery. 2 patients with dural tear and 2 patients with postoperative LBP. No recurrence and segmental instability was observed in the last follow-up.Conclusion TPLF-PELD could be a good alternative option for the treatment of LLSC stenosis patients whose stenotic region occurred in both zone 1 and 2.

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