Unilateral Tubular Approach for Bilateral Laminectomy: Effect on Ipsilateral and Contralateral Buttock and Leg Pain

Abstract

Introduction Tubular laminectomy is an effective treatment for lumbar spinal stenosis (LSS) with neurogenic claudication and leg pain. Many surgeons agree that tubular approach results in a more complete decompression of the contralateral thecal sac and nerve root, as compared with the ipsilateral side. With this study, we sought to answer the question whether this is reflected in clinically significant differences between right- and left-sided postoperative leg pain. Materials and Methods First, all patients with LSS who underwent MIS laminectomy through tubular retractors between 2004 and 2011 were identified (110 patients). Among those, two groups of patients were included in the study: patients with equal preoperative leg VAS scores and paint s with unequal leg VAS scores. At the latest follow-up, in the equal pain group the extent of VAS score improvement on the approach side was compared with the extent of improvement on the contralateral side. Also, at the latest follow-up, in the unequal pain group, the extent of dominant side pain improvement was compared between the patients who were approached ipsilaterally to the painters who were approached contralaterally. Results In the equal pain group, at the latest follow-up of 25.8 ± 3.4 months, leg VAS scores were significantly improved both on the ipsilateral and the contralateral side compared with before surgery ( p < 0.001 and p = 0.001, respectively). In the unequal pain group, at the latest follow-up of 31.3 ± 3.7 months, leg VAS scores were significantly improved only on the contralateral side of the approach ( p < 0.001). In the equal pain group, there were no statistically significant differences between the extent of pain improvement on the ipsilateral and on the contralateral side. Conclusion Minimally invasive tubular laminectomy through a unilateral approach results in effective bilateral decompression. Disclosure of Interest None declared