Dr. Jho's Endoscopic Decompression via Microforaminotomy for Lumbar
Stenosis: Minimally Invasive Lumbar Stenosis Surgery : Low Back Surgery
Dong Jho, M.D., Ph.D.
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Pathoanatomy of lumbar stenosis
Lumbar stenosis is a condition in which the spinal canal (where spinal nerves pass) is narrowed and causes symptoms by compression of the spinal nerves. It can be subdivided into congenital stenosis and acquired stenosis.
Congenital stenosis can occur with particular diseases; however, it can also occur in the general population (who do not have any particular disease conditions). Some people are born with a relatively narrow spinal canal. They may remain asymptomatic until a minor degenerative process causes further narrowing of the spinal canal.
Acquired stenosis is the second and most common type, which is due to degenerative changes. With degeneration of the disc, the height of the disc decreases while the width of the disc increases, accompanied by protrusion of the disc and bone spur formation at the edge of the vertebrae. The facet joints, which are the two sliding articular joints at the posterior portion of the spinal motion unit, develop arthritic changes that consist of bone spur formation and overgrowth of the joint capsule. Narrowing of the spinal canal (lumbar stenosis) occurs with the combination of changes in the disc and facet joints.
Symptoms of lumbar stenosis
Most patients complain of low back pain as their main symptom. However, there is usually no direct correlation between the degree of spondylotic changes and the degree of low back pain. The narrowing of the spinal canal can occur diffusely or focally. Focal stenosis can cause symptoms related to the nerve root that is compressed. It can cause severe sharp pain in the leg, or burning and numbing sensations in the leg. Diffuse stenosis can cause burning and numbing sensations or pain in the leg, difficulty in walking, weakness in the legs, muscle loss, and difficulty in bowel and bladder control. Patients develop those symptoms when they try to walk some distance (neurogenic claudication). When they sit down or bend forwards for a few minutes, they will note improvement of their symptoms. The symptoms improve in this position because their spinal canal opens up to some degree when the spine bends forward. Riding a bike is easier for them than walking because riding a bike keeps their lumbar spine bent forward. Pushing a supermarket cart with a leaning-forward posture is often easier for patients also.
Treatments consist of conservative treatments and surgical treatments. Conservative treatments include medications, physical therapy, chiropractic treatment, local blocks, epidural blocks, steroid treatment, etc. When conservative treatments do not improve their symptoms, surgical treatments may be required.
For focal stenosis, surgical treatment is directed to release of compression at the exact pathologic site. For diffuse stenosis, conventional surgical treatment is decompressive laminectomy. Dr. Jho developed endoscopic decompression surgery for focal stenosis as well as diffuse stenosis. Dr. Jho's endoscopic decompression for focal stenosis accomplishes release of compression by providing the compressed nerve with a wider passage route. Dr. Jho's endoscopic decompression of diffuse stenosis achieves widening of the narrowed spinal canal bilaterally through a small foraminotomy hole. By doing so, most bony anatomy is preserved (contrary to the conventional laminectomy technique). Dr. Jho's technique eliminates the use of bone fusion or metal implants that have been in common use by spine surgeons in recent years.
Facts About This Surgery
- Minimizes bone resection maintaining spinal integrity while widening
the lumbar spinal cord canal
- Is less invasive because it incorporates a small hole through part
of the vertebra rather than removing an entire portion of vertebral bone
- Is innovative because it accomplishes effective widening of narrowed
spinal cord canals without weakening the spine
- Can be done on multiple levels if necessary
- Avoids the use of metal implants and bone fusion, and allows the patient to be more
mobile after surgery
- Is often done on an overnight basis
Degenerative spondylotic spine disease which causes break down of vertebrae,
narrows the spinal cord canal and can lead to symptoms of pain, numbness,
tingling, weakness, and difficulty walking and passing urine. As an analogy,
picture a coal mine tunnel that has partially collapsed making the passageway
narrow in some areas. This condition is referred to as lumbar stenosis.
Conventional surgical treatment involves removing large portions of bone by laminectomy.
A new procedure has been developed to achieve widening of the canal while
only making small holes in the bone, referred to as endoscopic microforaminotomy,
so as not to weaken the overall structure of the spine and to decrease
postoperative discomfort. This is all accomplished through a small incision
and allows the patient to usually go home the following day.
Jho, HD: Microdecompression via unilateral laminotomy for spondylotic
lumbar stenosis: Technical note. (In preparation)
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