Clinical outcomes following decompression of central canal and lateral recess simultaneous stenosis, with a focus on multilevel stenosis: A randomized comparison of microscopic bilateral laminotomy versus total laminectomy with posterior spinal fusion.

Abstract

In patients with simultaneous lumbar central spinal stenosis (LCSS) and lateral recess stenosis (LRS) at multiple levels, spinal decompression using microscopic bilateral laminotomy was compared to total laminectomy plus medial facetectomy and fusion (LF). From 2017 to 2022, this trial was performed to examine 96 patients with concomitant LCS and LRS at multilevel. Of the 96 patients, 48 were allocated to the following groups: LF (Group I) or microscopic bilateral laminotomy (Group II). However, 76 patients completed the study. We compared the outcomes in these two groups. Microscopic bilateral laminotomy was superior in most outcome measures. Delta-visual analogue scale (VAS) leg pain in Group II was significantly greater than in Group I (Mean-Group I: 4.368 vs. Group II: 5.368, P-value = 0.001). Complication and revision rates were lower in the microscopic bilateral laminotomy than in Group I, except for incidental durotomy occurrence (Group II: 31.58% - Group I: 7.89%, P-value = 0.0190). The rate of revision surgery for Group I compared with Group II was 44.74% versus 13.16% (P-value = 0.0047), indicating the superiority of laminotomy over LF. The mean Length of hospital stay was 3.551± 0.6349 in Group II versus in 6.774 ± 1.197 Group I (p-value <0.0001). Also, blood loss during surgery was significantly lower in Group II (p-value <0.0001). The findings indicate that microscopic bilateral laminotomy provides favorable clinical and radiological outcomes for individuals experiencing multilevel lumbar central canal and lateral recess stenosis. However, a higher frequency of durotomy may occur during microsurgical procedures.