Long Term Results and Efficacy of Facet Sparing Laminectomy with Fusion vs. Young Laminoplasty for the Treatment of Degenerative Spinal Stanosis

Abstract

Introduction: Laminectomy with fusion, traditional technique for lumbar decompression has been recently almost totally replaced with many less invasive surgical techniques allegedly equally effective. Aim: The aim of our study was comparison between long-term outcomes of Young laminoplasty (YL) as one of the less invasive techniques and facet sparing laminectomy with augmented posterolateral fusion (FSL). Patients and Methods: Patients with history of neurogenic claudication and lumbar stenosis (FSL and YL mean ?/− SD dural sac area (mm2) 53.6 ± 8.39 vs 54.1 ± 10.11 ; t=0.179; p = 0.859) were surgically treated. Instability and spondylolisthesis were exclusion criteria. Primary endpoints were to determine duration of surgery, blood loss, incision length and hospital stay. Secondary endpoints were to determine difference in the Oswestry Disability Index (ODI) and Prolo scale at 1-year and 8-year follow-up examinations. Results: 44 patients out of 56 patients were enrolled. Twenty- six patients were randomized in FSL (No=13) and YL (No=13) groups while 18 were allocated in observational FSL (No=13) and YL (No=5) cohorts. Using ODI scale significant improvement on 1-year and 8-year follow-up was noticed in FSL and YL groups. FSL ODI and YL ODI after one year follow up (24.22 ± 1.892 28.01 ± 1.945 respectively). FSL ODI was significantly better compared with YL at 8-year follow-up (27.82 ± 1.918 vs 40.74 ± 2.163). Using Prolo scale significant improvement on 1-year and 8-year follow-up was noticed in FSL and YL groups. FSL Prolo and YL Prolo after one year follow up. (8.90 ± 0.72, 7.65 ± 0.59 respectively). FSL Prolo was significantly better compared with YL Prolo score at 8-year follow-up (8.15 ± 0.64, 6.38 ± 0.53 respectively). Conclusion: Facet sparing laminectomy with fusion is a more invasive and more expensive surgical technique than Young laminoplasty. Facet sparing laminectomy with fusion is in a short-term and in a long-term follow up more successful operative technique and that difference increases in time.