Degenerative lumbar spinal canal stenosis surgery by endoscopy approach

International Journal of Medical Sciences And Clinical Research

105

https://theusajournals.com/index.php/ijmscr

VOLUME

Vol.05 Issue02 2025

PAGE NO.

105-110

DOI

10.37547/ijmscr/Volume05Issue02-20

Degenerative lumbar spinal canal stenosis surgery by
endoscopy approach

Eshkulov Dostonjon Ilkhomovich

Republican Specialized Scientific and Practical Medical Center of Traumatology and Orthopedics, Ministry of Health of the Republic of
Uzbekistan (Tashkent), Tashkent Medical Academy, Uzbekistan

Khujanazarov Ilkhom Eshkulovich

Republican Specialized Scientific and Practical Medical Center of Traumatology and Orthopedics, Ministry of Health of the Republic of
Uzbekistan (Tashkent), Tashkent Medical Academy, Uzbekistan

Received:

24 December 2024;

Accepted:

26 January 2025;

Published:

28 February 2025

Abstract:

Lumbar degenerative spinal canal stenosis (LDSS) is a prevalent condition that significantly impacts the

quality of life of patients, leading to substantial economic costs in the healthcare system. It is commonly observed
in individuals aged over 50 and is primarily caused by degenerative disc disease. Traditional treatment options,
including laminectomy, come with potential complications, including nerve damage, infection, and prolonged
recovery times. An emerging alternative is percutaneous spinal lumbar decompression (PSLD), a minimally
invasive procedure that aims to reduce these complications while improving clinical outcomes.

Methods: The study was conducted at the Republican Center of Traumatology and Orthopedics in Uzbekistan
from 2020 to 2025. A total of 50 patients diagnosed with lumbar spinal stenosis were included in the analysis. The
patients were divided into two groups: the endoscopic PSLD group (n=27) and the traditional decompressive
surgery group (n=23). All patients underwent preoperative assessments using radiography, multislice computed
tomography (MSCT), and magnetic resonance imaging (MRI) to evaluate spinal canal dimensions, foraminal
opening size, and the severity of stenosis. Visual Analog Scale (VAS) used for evaluation of pain. Statistical
analyses, including t-tests and chi-square tests, were used to compare outcomes between the two groups, with a
significance level set at p<0.05.

Results: The mean age of patients in the endoscopic PSLD group was 56.86 ± 7.7 years, and in the traditional
surgery group, it was 54.25 ± 5.08 years, with no significant difference observed between the two groups in terms
of age. Postoperatively, the mean VAS score for the traditional surgery group was 3.8 (SD=0.96), while for the
endoscopic PSLD group, it was significantly lower at 2.51 (SD=1.01), indicating that the PSLD group experienced
significantly less postoperative pain (p<0.05).

Conclusion: This study demonstrates that endoscopic PSLD is a promising alternative to traditional decompressive
surgery for the treatment of lumbar stenosis. The procedure offers significant advantages in terms of
postoperative pain relief and reduced recovery time, making it a favorable option for patients.

Keywords:

Lumbar spinal stenosis, endoscopic PSLD, Visual Analog Scale (VAS), degenerative disc disease, lumbar

decompression surgery.

Introduction:

Lumbar degenerative spinal canal

stenosis is a significant medical and social problem that
affects the quality of life of patients and imposes a
substantial economic burden on the healthcare system
due to the complexities of treatment. The prevalence
of lumbar spinal canal stenosis is estimated to be

between 11

–

39% based on clinical diagnoses and 11

–

38% based on radiological data [6]. The frequency of
lumbar spinal stenosis increases sharply in individuals
over 50 years of age, reaching between 1.8% and 8% in
this age group. According to Danish studies, lumbar
spinal stenosis occurs at a rate of 272 cases per

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International Journal of Medical Sciences And Clinical Research (ISSN: 2771-2265)

1,000,000 population per year [5]. Such patients
complain of a "burning, aching, twisting" sensation, and
even minimal irritation can trigger a burning pain.
Another classic symptom of lumbar spinal stenosis is
episodes of painful muscle spasms (cramps) in the calf
or foot area [7, 11]. The complexity of the disease lies
in the fact that the symptoms significantly impact the
quality of life of patients. Among patients with a
combination of leg and lower back pain, 70% report
equal intensity of pain in both areas, while in 58% of
cases, the pain is localized to one leg, and in 42%, it is
bilateral 12% [5]. When walking and standing, these
patients exhibit signs of cauda equina root dysfunction:
bilateral radicular pain, sensory disturbances, and
decreased muscle strength in the legs. When the
patient lies down, these symptoms resolve quickly, and
neurological examination in the lying position does not
reveal any abnormalities. Myelography shows a block
with signs of extradural compression [10].

The origin of the disease can be mainly of two types:
acquired and congenital. Congenital stenosis occurs
relatively rarely, accounting for about 5-9% of cases.
This condition arises when a person is born with a
naturally narrow spinal canal. Acquired lumbar stenosis
is the most common cause, accounting for about 90-
95% of cases in elderly individuals [1]. Degenerative
disc disease is often the primary factor leading to
intervertebral

disc

weakness

syndrome.

As

intervertebral discs undergo degeneration, they lose
height and hydration, which can result in protrusion
and herniation [4]

Furthermore, subgroups can be combined, creating
heterogeneous patient cohorts. In lumbar stenosis,
narrowing of the central spinal canal, lateral recess,
intervertebral foramen, and the area where the nerve
root exits the intervertebral foramen, or a combination
of these, leads to compression of the respective
structures. Currently, there are several surgical
approaches to treat the condition, with laminectomy
being a relatively common surgical procedure [3].
Although this method can be highly effective in treating
conditions such as spinal canal stenosis, herniated
discs, or spinal tumors, there are several drawbacks
and complications associated with the procedure,
including infection, nerve damage, bleeding, and
others [8].

Traditional treatment of intervertebral disc herniations
and degenerative spinal stenosis is associated with a
range of complexities and potential complications,
including prolonged recovery periods, significant pain,
risk of infection, nerve structure damage, and possible
development of spinal instability due to the removal of
bony structures (such as the lamina). These
complications can significantly limit functional

outcomes and the long-term quality of life of the
patient.

Due to these drawbacks, the use of the percutaneous
spinal lumbar decompression (PSLD) method,
developed by South Korean neurosurgeon Dr. Kim Taek
Lim, represents an optimal approach for treating this
pathology. This method employs a minimally invasive
interlaminar decompression technique, effectively
relieving pressure on nerve roots and the spinal canal,
while significantly reducing recovery time and
minimizing risks associated with open surgery.

The interlaminar decompression method within PSLD
involves the removal of only the tissues that directly
compress nerve structures, ensuring a more precise
and gentle intervention. This also reduces the
likelihood of complications such as nerve root damage,
infection, or excessive bleeding [2].

The study aim

to improve the outcomes of surgical

treatment for patients with degenerative lumbar spinal
stenosis through the use of endoscopic methods aimed
at minimizing tissue trauma.

METHODS

The study was conducted at the Republican Center of
Traumatology and Orthopedics in Uzbekistan from
2020 to 2025. To assess spinal canal dimensions and
the severity of degenerative stenosis, all patients
underwent

radiography,

multislice

computed

tomography (MSCT), and magnetic resonance imaging
(MRI). A total of 50 patients diagnosed with lumbar
spinal stenosis who underwent either endoscopic
posterior spinal lumbar decompression (PSLD) (n=27)
or conventional decompressive surgery (n=23) were
included. The study population consisted of individuals
aged 44 to 84 years, comprising 22 males (44%) and 28
females (56%). Endoscopic decompression was
performed using the PSLD technique. The severity of
preoperative and postoperative symptoms was
evaluated using the Visual Analog Scale (VAS) and other
clinical indicators. Data collected included patient age,
sex, lumbar spinal canal stenosis (LSCS) classification,
spinal cord dimensions, foraminal opening size, and
symptom severity. Statistical analyses involved t-tests
for continuous variables and chi-square tests for
categorical variables. Additionally, paired t-tests were
used to compare preoperative and postoperative
outcomes, with statistical significance set at p<0.05.

RESULTS

A total of 50 patients diagnosed with lumbar stenosis
were analyzed. The mean age in the endoscopic PSLD
group was 56.86 ± 7.7 years, while in the traditional
surgery group, it was 54.25 ± 5.08 years. No statistically
significant difference was observed between the two

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groups in terms of age.

However, a significant gender disparity was found (p =
0.003). In the endoscopic PSLD group, 19 patients
(70.3%) were female, whereas in the traditional surgery
group, only 8 (30.7%) were female. Preoperatively, 15
patients (55%) in the endoscopic PSLD group were
classified as Schizas Type C LSCS, compared to 10
patients (43%) in the traditional surgery group. No
statistically significant differences were observed
between the two groups in terms of the three classified
stenosis sizes before the surgery. Among all patients,
the most commonly reported symptoms were chronic
pain (37 patients, 74%), neurogenic intermittent

claudication (36 patients, 72%), and sensory deficits (35
patients, 70%). The most common complaints in the
traditional surgery group were restriction of the static-
dynamic function of the spine in 19 patients (82%),
neurogenic intermittent claudication in 20 patients
(86%), and sensory deficits in 17 patients (73%) and not
statistically significant found. Neurogenic intermittent
claudication was reported in 16 patients (59%) in the
endoscopic PSLD group and 20 patients (86%) in the
traditional surgery group, with a statistically significant
difference (p = 0.03) Table 1.

Table 1:

Demographic and clinical characteristics of Patients

Variables

Total

Endoscopic surgery

(N=27)

Traditional

surgery

(N=23)

p-value

Age (Mean, ± SD)

55.62

56,86 ±7,7

54,25 ±5,08

0.44*

Sex

Male (N/%)

22 (44%)

9(39.1%)

14(60.9%)

0.003**

Female (N/%)

28 (56%)

19 (70.3%)

8(30.7%)

LSCS classification by Schizas

C (N/%)

25 (50%)

15 (55%)

10 (43%)

0.15**

D (N/%)

25 (50%)

12 (45%)

13 (57%)

Anteroposterior size of the spinal

cord (mm, ± SD)

3.1

3.88 ±1.09

2.98 ±0.05

0.47*

Transverse size of the spinal cord

(mm, ± SD)

3.9

3.23 ±0.62

3.09 ±1.21

0.97*

Anteroposterior diameter of the

foraminal opening (mm)

3.21

3.18 ±0.69

3.18 ±0.69

0.8*

Symptoms

Visual Analog Scale (VAS) for

Pain Intensity

8.3 ±0.95

8.1 ±0.94

0.65*

Chronic pain (N, %)

37(74%)

14 (54%)

13(56%)

0.87**

Muscle-tonic syndrome (N, %)

24 (48%)

12 (44%)

12 (52%)

0.58**

Restriction of the static-dynamic

function of the spine (N, %)

37 (48%)

18 (66%)

19 (82%)

0.2**

Neurogenic intermittent

claudication (N, %)

36 (72%)

16 (59%)

20 (86%)

0.03**

Sensory deficits (N, %)

35 (70%)

18 (66%)

17 (73%)

0.57**

Disorders of pelvic organ

function (N, %)

23 (46%)

12 (44%)

11 (47%)

0.057**

*T-test, **Chi-Squared test

In the analysis of spinal cord measurements, including
the anteroposterior size of the spinal cord, transverse
size of the spinal cord, and anteroposterior diameter of
the foraminal opening, no significant differences were
observed between the two types of surgery.
Specifically, the Traditional Laminectomy group had a

mean anteroposterior size of the spinal cord of 7.7 mm,
while the Endoscopic PSLD group had a slightly larger
mean of 8.11 mm. However, the p-value of 0.31
indicates that this difference is not statistically
significant (Table 2)

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Table 2:

Comparision size of spinal cord before and after surgery

Parameters

Traditional

laminectomy

Endoscopic

PSLD

p-value

Anteroposterior size of the spinal cord (mm)

7.7

±

1.39

8.11

±

1.44

0.31

Transverse size of the spinal cord (mm)

11.29

±

0.7

11.57

±

0.50

0.13

Anteroposterior diameter of the foraminal

opening (mm)

7.3

±

0.75

7.52

±

0.8

0.55

Before surgery, the Visual Analog Scale (VAS) analysis
revealed no significant differences between the two

groups. However, post-surgery results showed that the
mean VAS score for the traditional treatment group
was 3.8 (SD = 0.96), while the

1-Figure. Comparison of VAS Before and After Surgery

mean VAS score for the endoscopic PSLD group was
2.51 (SD = 1.01). This difference was statistically
significant (Graph 1).

DISCUSSION

In this study, the mean age of patients in both groups
was comparable, with no significant differences
observed between the groups. However, there was a
notable gender disparity, as a higher proportion of
females were present in the endoscopic PSLD group
compared to the traditional surgery group (p = 0.003).
This gender difference may reflect a selection bias or a

preference for less invasive treatment options among

females. In terms of spinal cord measurements,
including the anteroposterior size of the spinal cord
and the transverse size of the spinal cord, no significant
differences were noted between the two surgical
techniques. This suggests that both endoscopic PSLD
and traditional surgery provided similar anatomical
outcomes in terms of spinal cord dimensions and
foraminal opening size.

Most notably, post-surgery VAS scores revealed a
significant difference between the groups. The mean
VAS score for the traditional surgery group was 3.8 (SD
= 0.96), while the endoscopic PSLD group showed a
lower mean score of 2.51 (SD = 1.01). This finding

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indicates that patients who underwent endoscopic
PSLD experienced significantly less postoperative pain
than those who underwent traditional surgery, which
could be attributed to the less invasive nature of the
endoscopic procedure.

CONCLUSION

In conclusion, this study highlights the potential

advantages of endoscopic PSLD over traditional surgery
for the treatment of lumbar stenosis. Although both
groups were similar in terms of preoperative
characteristics,

the

endoscopic

PSLD

group

demonstrated significantly lower postoperative pain
levels, as evidenced by the reduced VAS scores. While
both techniques showed similar anatomical outcomes,
the endoscopic PSLD procedure offers a less invasive
alternative with promising results in pain relief and
symptom management. These findings suggest that
endoscopic PSLD could be a beneficial option for
patients with lumbar stenosis, warranting further
investigation into its long-term effectiveness and
broader applicability

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