Abstract
Aims This study was aimed to compare the perioperative and postoperative outcomes of patients who underwent posterior decompression for multi-segmental lumbar spinal stenosis by microendoscopic laminotomy (MEL) versus spinous process-splitting laminotomy (SPSL) retrospectively.MethodsWe retrospectively reviewed 73 consecutive patients who underwent two or three levels MEL (n=51) or SPSL (n=22) for lumbar spinal stenosis between 2012 and 2018. The perioperative outcomes were operative time, intraoperative blood loss, length of postoperative hospital stay, complications, and reoperation rate. The postoperative outcomes were evaluated using a visual analog scale (VAS) and the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) scores at one year postoperatively.ResultsThe mean follow-up time was 26.6 months in MEL and 35.6 months in SPSL. The mean operative time was significantly longer in MEL than SPSL (two levels, 183.6 ± 43.2 versus 134.8 ± 26.7 min, respectively; three levels: 241.6 ± 47.8 versus 179.9 ± 28.8 min, respectively). MEL's mean postoperative hospital stay was significantly shorter than SPSL (12.3 ± 5.9 versus 15.5 ± 7.2 days, respectively). There was no significant difference in the mean intraoperative blood loss, complication rate, reoperation rate, and postoperative outcomes between the two groups.ConclusionsThis study suggests that both techniques are effective in treating multi-segmental lumbar spinal stenosis. There was no significant difference between the two procedures in intraoperative blood loss (IBL), complications rate, reoperation rate, or improvement in VAS and Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) scores. MEL had an advantage in the postoperative hospital stay.
Highlights
In treating lumbar spinal stenosis, minimally invasive surgery has been increasingly utilized to preserve the paraspinal muscle attachments and the posterior ligamentous complex, which are associated with postoperative back muscle atrophy and lumbar instability, and low back pain [1,2]
The mean operative time was significantly longer in Microendoscopic laminotomy (MEL) than spinous process-splitting laminotomy (SPSL)
There was no significant difference in the mean intraoperative blood loss, complication rate, reoperation rate, and postoperative outcomes between the two groups
Summary
In treating lumbar spinal stenosis, minimally invasive surgery has been increasingly utilized to preserve the paraspinal muscle attachments and the posterior ligamentous complex, which are associated with postoperative back muscle atrophy and lumbar instability, and low back pain [1,2]. In 2002, Palmer et al [4] described the performance of unilateral laminectomy for bilateral decompression using a micro endoscope for lumbar spinal stenosis. MEL for lumbar spinal stenosis has been recognized to have several advantages, such as smaller incisions, less blood loss, and a shorter hospital stay than conventional open laminectomy [5,6,7,8,9]. Another technique, spinous process-splitting laminotomy (SPSL), was developed by Watanabe et al [10]. SPSL for lumbar spinal stenosis has demonstrated better clinical results than conventional open laminectomy [11,12,13]
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