Full Endoscopic Laminectomy for Lumbar Spinal Canal Stenosis Using DPEL Scope With Special Reference to Its Effectiveness and Complications

Iida K, Kashiwagi N, Shibashiro S, Kakumoto S, Nakamura C and Shastzmiller S

Published on: 2024-08-19

Abstract

The purpose of this study was to retrospectively investigate the effects and complications of DPEL scope.

Fifty-two patients were included in this study group. Follow-up period was 14.3?2-47?months after operation.

The JOA score was 15.4 (5-19) points preoperatively and improved to 27.0 (19-29) points at the final follow-up (P<0.0001). The improvement ratio was 85 %.

Complications occurred in 4 patients (8%) during the first 2.5 years of surgery. One patient (2%) had a nerve root injury on the contralateral side with extensive removal of the yellow ligament, which recovered within one year of surgery. In the other three patients (6%), dural tears occurred during removal of the yellow ligament. In two of these three patients, the tear was caused by the dura adhering to the yellow ligament. However, the cauda equina did not prolapse. In the remaining case, the cauda equina prolapsed due to grasping the dura and the yellow ligament with the Kerrison Rongeurs?

The dural tears in these 3 patients were treated by using 2-3 layers of a combination of PGA (Polyglycolic acid) sheet and the subcutaneous free fat tissue. This technique was effective in 2 patients without cauda equina prolapse. They did not complain of symptoms of cerebrospinal fluid leakage and were discharged from hospital as scheduled. In one patient grasped by Kerrison Rongeurs, severe leg pain occurred on motion and prevented the patient from leaving the bed. In the end, the dural tear was sutured on the 6th day after surgery.

The DPEL scope was effective for laminectomy of lumbar spinal canal stenosis. However, dural tear occurred during removal of the yellow ligament in three patients (6%). The combination of 2-3 layers of PGA (Polyglycolic acid) sheet with free fat tissue graft was effective for repair of the dural tear in two patients (67%) without prolapsing cauda equina.