Assessment of Clinical Outcome of Bilateral Decompression through Unilateral Approach in Lumbar Canal Stenosis

Abstract

Background Data: Acquired degenerative lumbar canal stenosis is considered a common indication for lumbar spine surgery in old patients. The traditional approach is wide open laminectomy, medial facetectomy, and foraminotomy, which includes bilateral muscle separation and extensive excision of the posterior spinal structures. Minimal invasive surgeries as microsurgical and endoscopic have been now used for the treatment of lumbar canal stenosis during the last years.Purpose: To assess clinical outcome of unilateral approach in bilateral decompression of lumbar canal stenosis.Study Design: Observational analytic prospective study.Patients and Methods: Twenty patients with degenerative lumbar canal stenosis have undergone bilateral decompression from unilateral approach at Ain Shams university hospitals between May 2014 and April 2016. Prospective analysis of their clinical outcome was conducted.Results: In this study twelve were male (60%) and eight were female (40%). The mean age was 43.1±12.33 (range 35-55years). The duration of clinical presentation ranged from 6 to 24 months. Preoperative clinical presentation was low back pain (95%), sciatica (85%), neurogenic claudication (100%) and sensory changes (80%). Marked improvement of preoperative leg pain has been observed after surgical decompression. Significant reduction of the mean preoperative VAS (7±0.72) (over all back and leg pain) to VAS 2±0.72) at one, (1.85± 0.58) at three and (1.6± 0.68) at 6 months (P>0.001). The mean ODI scores decreased significantly at one (27±9.78), three (23±7.3) and six months (21±4.47) from the mean preoperative ODI score (61±4.47) (P>0.0001). Accidental durotomy was reported in one patient (5%) and it was in the posterior dura under the opposite lamina just off the midline.Conclusion: Unilateral approach in bilateral decompression is an effective procedure for management of lumbar canal stenosis. (2016ESJ119)