Our experience with minimally invasive decompression spine surgeries performed with microscopic and endoscopic visualization

Introduction: The rapid development of minimally invasive techniques did not leave neurosurgery untouched either. New surgical interventions, both skull and spine surgery, are gaining more and more popularity. Due to the aging society, previously inoperable degenerative abnormalities are also receiving more and more attention. In the treat-ment of spinal canal stenosis caused by degenerative changes, the initially used laminectomy was replaced by unilat-eral "over-the-top" surgery, and in recent years, by techniques that ensure the least possible collateral tissue damage, such as tubular retractor and then spinal endoscopy. Objective: The purpose of this study is to use the experiences of the past years to present the decompression surgeries performed with two minimally invasive techniques, i.e., the tube explorer and the endoscope, and their results, pro- viding an insight into international spine surgery trends. Method: From January 1, 2022 to December 31, 2022, we operated 43 patients with spinal canal stenosis using this techniques. In 27 of these cases, we used a tube retractor and a microscope, while in 16 cases, we used an endo- scopic technique. In order to evaluate the results, we took a visual analogue scale value before and after the interven- tion to evaluate neurogenic claudication, lower back pain that worsens with exercise, and radicular pain at rest. Based on this, the patients were divided into four groups: using unchanged (0-30%), moderate (31-50%), good (51-75%) and excellent (76-100%) ratings. We separately analyzed surgeries for stenosis combined with spondylolisthesis. We evaluated our short-term results based on the average value of hospitalization days. Results: We achieved excellent postoperative results for all examined symptoms, i.e., neurogenic claudication in 95.3%, lower back pain in 72.4%, while the symptoms of restlessness disappeared almost completely in 86.9% of the cases. Accordingly, we experienced good and moderate results in much smaller proportions. The results after decom- pression surgery for spinal canal stenosis caused by spondylolisthesis were evaluated separately, based on which the postoperative results of neurogenic claudication in 92.8% of cases, low back pain in 70%, and pain at rest in 100% proved to be excellent. The average number of the hospitalisation days was 3.7. Discussion and conclusion: Our experience is in line with the international results, which suggest that the results of minimally invasive techniques using the tube explorer and the endoscope can be further improved both in the short and long term. With the introduction of new techniques, we not only offer our patients a less invasive approach with better results, but due to the efficiency of the procedures, more patients can undergo surgery in a shorter time.