Unilateral Fenestration versus Open Laminectomy in Treatment of Degenerative Stenosis of Lumbar Spine

Abstract

Background: The syndrome of degenerative lumbar canal stenosis accounts for a large percentage of causes of low back pain in the elderly worldwide. Surgical management has demonstrated better clinical and radiological results than conservative treatment. It allows for adequate decompression of the thecal sac and the compressed nerve roots. However, aggressive laminectomy with facetectomy has been linked with many postoperative complications including instability. Hence, new less invasive modalities have been introduced such as fenestration and endoscopic laminotomy. Objective: This study aimed at comparing the safety and outcome of conventional laminectomy to unilateral fenestration in cases of lumbar canal stenosis. Patients and methods: It took place at the Neurosurgery Department at Zagazig University and included thirty six patients with lumbar canal stenosis; eighteen patients were treated by conventional laminectomy and eighteen patients were treated by unilateral fenestration. Results: Decompression led to an intense decrease of total pain in both groups. Matched with that experience in group I, but, with more remaining back and leg pain was found in group II, 6.58±0.99 and 6.75±0.96, respectively, compared with 2.16±0.57 and 2.75±0.86 , respectively, at the 12 weeks follow-up assessment (p < 0.001). The most obvious symptom of lumbar stenosis, neurogenic claudication improved in 91% of patients in group I compared to 83% in Group II. Patient satisfaction was higher in Group I, as the patients who underwent unilateral fenestration showed more decrease in total pain with 12 weeks postoperatively. Conclusion: Unilateral fenestration allows acceptable and safe decompression of the spinal canal in patients with degenerative lumbar stenosis.