Micro-endoscopic, tailored, spine decompression as a less invasive, stability-preserving, surgical option, alternative to instrumented correction, in complex spine deformities: a preliminary multicenter experience.

STUDY DESIGN: A series of 32 patients, submitted to a tailored stability-preserving micro-endoscopic decompression for lumbar spine degenerative disease was retrospectively analyzed.

OBJECTIVES: The aim of this study is to explore the effectiveness of a less invasive posterior spine decompression in complex deformities. We studied the potential advantages of the micro-endoscopic approach, supplemented by the piezoelectric technique, to decompress both sides of the vertebral canal, from a one side approach to preserve spine stability, ensuring an adequate neural decompression.

METHODS: The patients were submitted to a selective bilateral decompression, using a monolateral approach, without the skeletonization of the opposite side. For the omo- and the contralateral decompression, we used a microscopic endoscopy-assisted approach, with the assistance of Piezosurgery, for a safe work near the exposed dura mater. Piezoelectric osteotomy is extremely effective in bone removal while safe on soft tissues.

RESULTS: In all patients an adequate decompression was achieved with a high rate of spine stability preservation. The approach was essential in minimizing the opening, so reducing the risk of spine instability. Piezoelectric osteotomy was useful to safely perform the undercutting of the base of the spinous process, for a better contralateral vision and decompression without damaging the exposed dura. In all patients a various degree of neurological improvement was observed, with no immediate spine decompensation.

CONCLUSIONS: In selected cases, the tailored micro-endoscopic monolateral approach for bilateral spine decompression, with piezosurgery assistance, is adequate and safe and showed excellent results in terms of spine decompression and stability preservation.