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)
Highlights
Lumbar spinal stenosis refers to the anatomical narrowing of the lumbar spinal canal (LSS), and is associated with a spectrum of clinical symptoms
The purpose of this study is to evaluate the surgical outcome of patients having lumbar spinal stenosis who underwent unilateral approach for bilateral decompression surgery, and to compare outcomes between this approach and the bilateral conventional approach for bilateral neural decompression
All patients had the diagnosis of single segmental L4-L5 lumbar canal stenosis
Summary
Lumbar spinal stenosis refers to the anatomical narrowing of the lumbar spinal canal (LSS), 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.[18] The characteristic symptom of LSS is neurogenic claudication due to localized bony and/or discoligamentous narrowing of the spinal canal.[7,16] Factors responsible for the development of LSS include disc degeneration resulting protrusion with ventral narrowing of the canal and with consequent narrowing of the lateral recess and neural foramen This affects ligamentous laxity with subsequently increased segmental mobility and additional strain on the facet joints.[4,19] Bone structures react to this subclinical instability with osseous hypertrophy, which presents as hypertrophy of the facet joints. 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
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