Classification of Lateral Region of Lumbar Spinal Canal and the Choice of Endoscopic Approach

Degenerative lateral lumbar spinal canal stenosis commonly affects the elderly, leading to significant morbidity. This chapter aims to introduce a novel categorization for the lateral compartments of the lumbar spine and to assess the effectiveness of surgical interventions for this condition. A new anatomical classification has been established, partitioning the area into five distinct zones. To ascertain the consistency of this nomenclature, lumbar scans from thirty individuals with single-zone afflictions at our facility were reviewed by a trio of evaluators. Following this, we conducted a prospective study tracking the surgical results in 76 subjects with single-zone lateral lumbar canal narrowing over two years. These individuals were treated using either percutaneous endoscopic transforaminal or interlaminar decompression techniques, chosen based on the newly developed zonal system. Outcomes were evaluated using the Macnab criteria, and changes in leg pain were measured with the visual analog scale (VAS) before and after surgery. During the study employing our categorization, the average observation period was 15.6 months. By the final evaluation, 93.4% of the cases were rated as good or excellent. The average initial VAS score of 5.72 significantly improved to 1.26 within three months after surgery and further to 0.78 by the final assessment. Notably, two individuals experienced dural tears, and one had postoperative bone fragment migration into the vertebral canal. The findings suggest that this innovative lateral lumbar canal classification facilitates precise surgical planning, contributing to the high rate of satisfactory results following endoscopic procedures.