UNASSIGNED: Laminectomy has long been a \"gold standard\" to treat symptomatic lumbar spinal stenosis (LSS). Minimal invasive spine surgery (MISS) is widely developed to overcome the limitations of conventional laminectomy to achieve a better outcome with minimal complications. Full endoscopic percutaneous stenoscopic lumbar decompression (FE-PSLD) is the newest MISS technique for spinal canal decompression. We aimed to evaluate and analyze the significance of FE-PSLD in reducing pain and its association with age, duration of symptoms, stenosis level, and operative time (OT).
UNASSIGNED: A longitudinal cross-sectional study was conducted on 606 LSS patients who underwent FE-PSLD and enrolled from 2020 to 2022. Three-month evaluation of the Visual Analog Scale (VAS) and the modified MacNab criteria were assessed. The significance of changes was analyzed using the Wilcoxon signed-ranks test. Spearman\'s correlation test was performed to evaluate the significant correlation of several variables (pre-PSLD-VAS, age, symptoms duration, OT, and level of LSS) to post-PSLD-VAS, and multiple regression analysis was conducted.
UNASSIGNED: The reduction of VAS was statistically significant (P ≤ 0.005) with an average pre-PSLD-VAS of 6.75 ± 0.63 and post-PSLD-VAS of 2.24 ± 1.04. Pre-PSLD-VAS, age, and stenosis level have a statistically significant correlation with post-PSLD-VAS, while the duration of the symptoms and OT have an insignificant correlation. Multiple regression showed the effect of pre-PSLD-VAS (β =0.4033, P = 0.000) and stenosis level (β =0.0951, P = 0.021) are statistically significant with a positive coefficient.
UNASSIGNED: FE-PSLD is an efficacious strategy with favorable outcomes for managing LSS, shown by a significant reduction of pain level with a relatively short follow-up time after the procedure. Preoperative pain level, age, and stenosis level are significantly correlated with postoperative pain level. Based on this experimental study, PSLD can be considered a good strategy for treating lumbar canal stenosis in all age groups and all LSS levels.

The lumbar foramen is affected by different degenerative diseases, including extraforaminal disc herniation, foraminal stenosis (FS), and degenerative or spondylolytic spondylolisthesis. The purpose of this study was to describe percutaneous stenoscopic lumbar decompression with a paramedian approach (para-PSLD) for foraminal/extraforaminal lesions. All operative procedures were performed using a complete uniportal endoscopic instrument system. The para-PSLD can be easily applied to patients with FS and narrow disc space or facet joint hypertrophy. The anatomical view of a para-PSLD is similar to that of a conventional open surgery and allows for good visualization of the foraminal/extraforaminal areas. We suggest that para-PSLD is an alternative and minimally invasive procedure to treat degenerative lumbar foraminal/extraforaminal stenoses.

BACKGROUND: Incidental durotomy (ID) during surgery for lumbar herniated disks or lumbar spinal stenosis is a serious complication that requires immediate recognition and repair. The incidence of ID during percutaneous endoscopic lumbar decompression has increased along with the demand for endoscopic spinal surgery. The management of ID during endoscopic surgery is more complicated and difficult than management during open surgery. A hemostatic agent, TachoSil (Nycomed, Linz, Austria), is used for control of local bleeding in several types of surgery, but its use in dural repair in endoscopic spinal surgery has not been described.
METHODS: We present 3 cases in which the double-layer TachoSil packing technique was used in the management of ID during percutaneous stenoscopic lumbar decompression.
CONCLUSIONS: This case report reconfirms the efficacy and utility of TachoSil for IDs that occur during endoscopic spinal surgery and minimally invasive surgery. To our knowledge, this is the first report on the use and effectiveness of TachoSil for managing IDs during endoscopic spinal surgery. We hope that other surgeons will find this technique helpful in managing IDs.