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Subject Area

Degenerative, Minimally invasive procedures

Article Type

Original Study

Abstract

Background Data: Lumbar spinal stenosis refers to the anatomical narrowing of the lumbar spinal canal, and is associated with a spectrum of clinical symptoms. The annual incidence of lumbar spinal stenosis is reported to be five cases per 100,000 individuals.Purpose: The purpose of this study is to evaluate the surgical outcome of patients having lumbar spinal stenosis and underwent unilateral approach for bilateral spinal decompression surgery, and to compare outcomes with the conventional laminectomy approach.Study Design: This is a prospective randomized controlled study.Patients and Methods: This study included 21 patients with clinically manifest disco-ligamentous lumbar spinal stenosis without radiological instability. Eleven patients had bilateral neural decompression through a unilateral microscopic approach (unilateral laminectomy) (Group-I) and the other 10 patients had conventional laminectomy (Group-II).Clinical assessment was done using Visual Analogue Scale (VAS) and ODI. The patients were followed-up for 12 months postoperatively.Results: Thirteen patients were females and 8 were males. The mean age of unilateral approach group was 47.2 years, and 49.5 years for the conventional group. Reported duration of surgery was 100 minutes in group-I and 85 minutes group-II. Reported intraoperative blood loss was 84.7 cc in group-I, and 127 cc in group-II. Clinical improvement was achieved in both groups without significant difference in between regarding VAS and ODI. In group we reported unintended durotomy occurred in two patients, CSF leak in one patient, and hematoma in another patient. In group-I we had one patient of unintended durotomy, one patient had CSF leak, and one patient developed spondylolisthesis.Conclusion: Unilateral microscopic laminoforaminotomy with cross over the top technique, for bilateral neural decompression in lumbar spinal stenosis has equal efficacy and safety with minimal effect on stability and slight better postoperative back pain in comparison to conventional approach. (2017ESJ140)

Keywords

unilateral approach, Conventional laminectomy, hemilaminectomy, lumbar spinal stenosis, microscopic discectomy

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