Objectives

Juxtafacet cysts of the spine can cause radicular pain, neurological symptoms and are often associated with spinal degeneration. The mainstay of treatment of juxtafacet cysts is surgical resection with laminotomy and resection of the cyst. Other methods, including epidural steroid and facet injections are mostly temporarily effective. The aim of this study is the sufficient decompression with reduced traumatization and destabilization with the full-endoscopic interlaminar and transforaminal technique.

Introduction: A far lateral access is required in fullen-doscopic operations of sequestered lumbar disc herniations to achieve a sufficient decompression of the ventral epidural space. The conventional endoscopes and instruments had very narrow limits especially in the mobility and possibility to resect hard tissue and to clean the intervertebral space sufficiently. The aim of this prospective study was to investigate the extended possibilities of the new endoscopes and instruments with regard to the efficacy of decompression, the advantages and problems of this technique in comparison to previous data.

Methods: 368 patients with lumbar disc herniations have been treated in 2002 and 2003 in a full endoscopic transforaminal technique using a lateral access. A 7-mm endoscope with 4 mm-working canal and new designed instruments were used. Follow-up lasted at least 12 months. 298 patients (81%) could be followed.

Results: No intraoperative complication occurred. 6 patients reported a transient dysaesthesia postoperatively. The average operation time was 28 minutes. A sufficient decompression could be achieved in all cases. 244 patients (82%) reported no more leg pain after surgery, 42 patients (14%) had transient persistence in the first 6 weeks. 8 patients (2,7%) showed a recurrent herniation, 7 of those were reoperated in the same technique.

Discussion/Conclusion: As a minimally invasive technique wich efficacy of decompression is equal to an open procedure we see advantages over conventional operations of lumbar disc herniations. Within the inclusion criterias of indication this technique is sufficient and safe. The technical developments on endoscopes and instruments lead to a decrease of recurrence, increase of mobility as well as the possibility of resection of hard tissue and sufficient cleaning of the intervertebral space. The combination of a far lateral access with other approaches extends the spectrum of indications with regard to full endoscopic bony decompression and fusion.

Introduction: Revision procedures in pain syndromes following spinal operations can bring unsatisfactory results. When all therapies fail, there is the possibility of implantation of SCS. The 8-pole electrode and double-electrode technique broaden the spectrum. The purpose of this prospective study is to evaluate the results of the use of SCS in the technique cited in chronic lumbar pain syndrome of previously-operated patients.

Methods: An SCS system was implanted in 37 previously-operated patients (16 f, 21 m; mean age 42 years) with therapy-resistant chronic lumbar pain syndrome (duration 31–62 months, all MPSS Grade III). All patients had undergone multiple surgery (2–5 times). 13 patients had also undergone fusion operation. The daily morphine dose applied ranged from 60–200 mg MST retard or equivalent. All patients also presented with somatizing tendencies. In addition to general criteria special measuring instruments were used. The follow-up period lasted 3 years. All patients could be included.

Results: The external test phase lasted 15 to 45 days. 29 patients needed a double-electrode system. With the exception of one patient who was not included in the study, all patients desired permanent receiver implantation. Three times during the test phase there was dislocation of the electrode which could be corrected during receiver implantation. Three late dislocations could be corrected in one case by external repoling of the electrodes and in one case by revision under local anesthesia.. One patient required open implantation of a 16-pole plate electrode. All patients attained a reduction to MPSS grade II. The VAS revealed reduction by at least 4 categories, with maximum 7. Similar results were found in the specific back scores. In the SF-36, the level of the normal sample with back pain, ischias and disk damage was attained. The morphine dose could be reduced by at least 50%. 9 patients no longer required long-term medication. All results were stable throughout the follow-up period. All patients said they would have the procedure repeated.

Discussion/Conclusion: SCS in 8-pole and double-electrode technique is a sufficient procedure in the therapy of chronic lumbar pain syndrome in previously-operated patients. Accurate indication and test phase are necessary. Even somatizing tendencies do not represent an absolute contraindication. Special attention must be paid to the complication of electrode dislocation.