Clinical Efficacy of Interlaminar and Transforaminal Spinal Endoscopy in the Treatment of Lumbar Spinal Stenosis

Purpose: To compare the application effect of interlaminar technique (ILT) and transforaminal technique (TFT) spinal endoscopies in lumbar spinal stenosis (LSS) treatment. Material and Methods: The data of 46 patients aged 65 years or older diagnosed with LSS between January 2019 and March 2021 were retrospectively reviewed in this study. They underwent ILT (21 patients) or TFT (25 patients) spinal endoscopy surgery, and outcomes were analyzed utilizing the visual analog scale (VAS), Oswestry disability index (ODI), and Japanese orthopedic association (JOA) scale. Lumbar stability was also evaluated using the change in dynamic position X-ray of the spine. We also built three-dimensional (3D) finite element of ILT and TFT spine models and compared them with the stability of the intact spine. Results: The ILT group had a longer operation time than the TFT group, and patients in ILT and TFT groups had comparable VAS scores for back pain. However, the TFT group had higher VAS scores for leg pain than the ILT group 3, 6 and 12 months postoperatively. The JOA and ODI scores of the 2 groups improved after surgery, and there were statistical differences between the 2 groups at 6 and 12 months follow-up, which proved that functional recovery was better in ILT group. The pre-and postoperative change in dynamic position X-ray of the spine proved that ILT and TFT would not destroy the spine's stability. 3D finite element lumbar spine model analysis also demonstrated this point. Conclusion: Both ILT and TFT can provide good clinical outcomes; compared with TFT, the ILT approach provided more thorough decompression and was more suitable for treating LSS.