Conventional Laminectomy Research Articles

Prospective comparative analysis of three types of decompressive surgery for lumbar central stenosis: conventional, full-endoscopic, and biportal endoscopic laminectomy

Conventional open laminectomy has long been considered one of the important surgical options for lumbar central stenosis owing to its positive outcomes. However, newer approaches have emerged as alternatives, including full-endoscopic and biportal endoscopic laminectomy. Therefore, a comparison of the outcomes that are associated with each of these surgical methods is warranted. This prospective multicenter trial, initiated in February 2019, compared the outcomes of three lumbar central stenosis surgical approaches: open laminectomy (OPEN), uniportal endoscopy (UNIPORT), and biportal endoscopy (BIPORT). Among 115 participants from seven centers, one-year follow-ups assessed laboratory, radiological, and clinical outcomes. Despite all groups showing adequate decompression and clinical improvement, the OPEN group exhibited less improvement in Visual analog scale (VAS) for back pain scores (p < 0.05) and significant postoperative increases in most laboratory markers. Furthermore, the OPEN group experienced a significant decrease in multifidus muscle cross-sectional area compared to endoscopic groups (p < 0.001). Each surgical techniques produced similar clinical outcomes and dural space expansion. However, endoscopic surgery was associated with better muscle preservation and better relief of back pain. Endoscopic surgery is a reasonable alternative to conventional laminectomy for treating lumbar central stenosis.This trial was registered on CRIS (Clinical Research Information Service, KCT0004355).

Comparative Biomechanical Stability of the Fixation of Different Miniplates in Restorative Laminoplasty after Laminectomy: A Finite Element Study

A novel H-shaped miniplate (HSM) was specifically designed for restorative laminoplasties to restore patients’ posterior elements after laminectomies. A validated finite element (FE) model of L2/4 was utilized to create a laminectomy model, as well as three restorative laminoplasty models based on the fixation of different miniplates after a laminectomy (the RL-HSM model, the RL-LSM model, and the RL-THM model). The biomechanical effects of motion and displacement on a laminectomy and restorative laminoplasty with three different shapes for the fixation of miniplates were compared under the same mechanical conditions. This study aimed to validate the biomechanical stability, efficacy, and feasibility of a restorative laminoplasty with the fixation of miniplates post laminectomy. The laminectomy model demonstrated the greatest increase in motion and displacement, especially in axial rotation, followed by extension, flexion, and lateral bending. The restorative laminoplasty was exceptional in preserving the motion and displacement of surgical segments when compared to the intact state. This preservation was particularly evident in lateral bending and flexion/extension, with a slight maintenance efficacy observed in axial rotation. Compared to the laminectomy model, the restorative laminoplasties with the investigated miniplates demonstrated a motion-limiting effect for all directions and resulted in excellent stability levels under axial rotation and flexion/extension. The greatest reduction in motion and displacement was observed in the RL-HSM model, followed by the RL-LSM model and then the RL-THM model. When comparing the fixation of different miniplates in restorative laminoplasties, the HSMs were found to be superior to the LSMs and THMs in maintaining postoperative stability, particularly in axial rotation. The evidence suggests that a restorative laminoplasty with the fixation of miniplates is more effective than a conventional laminectomy due to the biomechanical effects of restoring posterior elements, which helps patients regain motion and limit load displacement responses in the spine after surgery, especially in axial rotation and flexion/extension. Additionally, our evaluation in this research study could benefit from further research and provide a methodological and modeling basis for the design and optimization of restorative laminoplasties.

Full endoscopic percutaneous stenoscopic lumbar decompression and discectomy: An outcome and efficacy analysis on 606 lumbar stenosis patients.

Laminectomy has long been a "gold standard" to treat symptomatic lumbar spinal stenosis (LSS). Minimal invasive spine surgery (MISS) is widely developed to overcome the limitations of conventional laminectomy to achieve a better outcome with minimal complications. Full endoscopic percutaneous stenoscopic lumbar decompression (FE-PSLD) is the newest MISS technique for spinal canal decompression. We aimed to evaluate and analyze the significance of FE-PSLD in reducing pain and its association with age, duration of symptoms, stenosis level, and operative time (OT). A longitudinal cross-sectional study was conducted on 606 LSS patients who underwent FE-PSLD and enrolled from 2020 to 2022. Three-month evaluation of the Visual Analog Scale (VAS) and the modified MacNab criteria were assessed. The significance of changes was analyzed using the Wilcoxon signed-ranks test. Spearman's correlation test was performed to evaluate the significant correlation of several variables (pre-PSLD-VAS, age, symptoms duration, OT, and level of LSS) to post-PSLD-VAS, and multiple regression analysis was conducted. The reduction of VAS was statistically significant (P ≤ 0.005) with an average pre-PSLD-VAS of 6.75 ± 0.63 and post-PSLD-VAS of 2.24 ± 1.04. Pre-PSLD-VAS, age, and stenosis level have a statistically significant correlation with post-PSLD-VAS, while the duration of the symptoms and OT have an insignificant correlation. Multiple regression showed the effect of pre-PSLD-VAS (β =0.4033, P = 0.000) and stenosis level (β =0.0951, P = 0.021) are statistically significant with a positive coefficient. FE-PSLD is an efficacious strategy with favorable outcomes for managing LSS, shown by a significant reduction of pain level with a relatively short follow-up time after the procedure. Preoperative pain level, age, and stenosis level are significantly correlated with postoperative pain level. Based on this experimental study, PSLD can be considered a good strategy for treating lumbar canal stenosis in all age groups and all LSS levels.

MANAGEMENT OF DISC HERNIATION AT THE LUMBAR REGION THAT IS COMPLICATED WITH SPINAL STENOSIS USING SMALL INCISION FENESTRATION

Objectives: The objective of the current study was to compare the alternative approach of smaller incision fenestration in managing lumbar disc herniation with spinal stenosis to previous conventional laminectomy procedures. Patients and methods: The current case-control study included a total of 290 patients who were represented by two groups. Those patients were complaining of herniation of the lumbar disc with a complication of stenosis of the lumbar segments. Patients in the study group were treated by a small incision fenestration approach, whereas patients in the control group were treated by posterior laminectomy and decompression. Those patients were selected retrospectively from the pool of patients visiting the orthopedic units of Adiwaniyah Teaching Hospital, Adiwaniyah province, Iraq. Results: Mean hospital stay of patients in the study group was lower in a significant way in comparison with that of patients in the control group, 6.03 ±2.08 days versus 8.07 ±3.13 days, separately (p&lt; 0.001). Added to that, mean operative loss was significantly lower in a group of intervention in comparison with the control group, 52.12 ±5.17 ml versus 65.48 ±5.08 ml, respectively (p&lt; 0.001). Added to that, mean operative time was lower in a significant way in the group of intervention in comparison with patients in the group of control, 62.62 ±3.09 minutes versus 87.09 ±3.47 minutes, respectively (p&lt; 0.001). The mean“visual analogue score (VAS)” was significantly lower in the study group in comparison with the control group, 3.09 ±1.15 versus 6.08 ±2.17, respectively (p&lt;0.001). A comparison of the mean “Japanese orthopedic association (JOA) score” for nerve function between the study group and the control group is shown in Figure 2. The mean “Japanese orthopedic association (JOA) score” was higher in a significant manner in the group of an intervention study in comparison with the control group, 27.15 ±3.07 versus 20.18 ±4.81, respectively (p&lt; 0.001). Conclusion: Small incision fenestration techniques are associated with significantly less hospital stay, less duration of operation, less blood loss, less visual pain score and better nerve function in comparison with conventional laminectomy procedure. Keywords: smaller incision fenestration, lumbar disc herniation, spinal stenosis

Is laminectomy necessary for C1-C2 epidural schwannomas?

Spinal schwannomas often require laminectomy for gross total resection. However, laminectomy may not be necessary due to the unique anatomy of epidural schwannomas at the C1-2 level, even with the intradural part. This study aimed to determine the need for laminectomy by comparing factors between patients who underwent laminectomy and those who did not and to identify the benefits of not performing laminectomy. Fifty patients with spinal epidural schwannoma confined to C1-C2 level were retrospectively collected and divided into groups based on whether laminectomy was intended and performed. In all cases where laminectomy was conducted, patients underwent laminoplasty using microplate-and-screws, which deviates from the conventional laminectomy approach. Tumor characteristics were compared, and a cut-off value for laminectomy was determined. Outcomes were compared between groups, and factors influencing laminectomy were identified. Postoperative changes in cervical curves were measured. The diameter of the intradural part of the tumor was significantly longer in the laminectomy performed group, with a 14.86mm cut-off diameter requiring laminectomy. Recurrence rates did not differ significantly between groups. Surgery time was substantially longer for the laminectomy performed group. No significant changes were observed in Cobb's angles of Oc-C2, C1-C2, and Oc-C1 before and after surgery. The study showed that the diameter of the intradural part of the tumor influenced the decision to perform laminectomy for removing epidural schwannomas at C1-C2. The cut-off value of the diameter of the intradural part of the tumor for the laminectomy was 14.86mm. Not performing laminectomy can be a viable option with no significant differences in removal and complication rates.

Unilateral Laminotomy vs. Conventional Laminectomy: Which is Better for Degenerative Lumbar Spinal Stenosis?

Objectives: To compare the outcomes of conventional laminectomy and unilateral laminotomy for lumbar spinal stenosis. Materials and Methods: The results of our research were compared between unilateral laminotomy (Group A) and conventional laminectomy (Group B) for lumbar spinal stenosis using a sample of 60 cases (30 in each group) selected through non-probability convenient sampling. We calculated the sample size using OPENEPI and analyzed the data with SPSS 26.0. For qualitative and quantitative data. Results: Mean age of participants was 49.7 years in both groups, The sample consisted of 37 male and 23 female participants made up the patient population. Dural tears (5%), progressive neurological deficit (0%), and surgical site infections (1%), among other postoperative complications, were all treated with antibiotics based on culture and sensitivity. Conclusion: Bilateral decompression via unilateral laminotomy is a less invasive alternative to conventional laminectomy for lumbar spinal stenosis, with significantly improved pain scores and minimized hospital stay. This technique offers appropriate decompression of neuronal components at the affected level with no increased risk of complications. Keywords: Degenerative, Spinal Stenosis, Unilateral Laminotomy, Conventional Laminectomy

The Outcome of Laminectomy versus Laminoforaminotomy in Terms of Claudication Distance in Lumbar Spinal Stenosis

Objectives: The study aimed to compare the surgical outcome of two different procedures for lumbar spinal stenosis. It helped us in the decision-making to go for less invasive procedures, as compared to conventional laminectomy in lumbar spinal stenosis patient patients.&#x0D; Materials and Methods: An interventional randomized controlled trial was conducted in the department of neurosurgery, Shaheed Zulfiqar Ali Bhutto Medical University, PIMS Islamabad. A total of 158 adult patients aged between 35 to 55 years with an established diagnosis of lumbar stenosis and claudication distance of fewer than 100 meters were enrolled. Patients were randomly included into two equal groups via the computerized method. In Group A laminectomy was done and in Group Blaminoforaminotomy was adopted. The outcome was measured in terms of claudication distance at 4 weeks after the procedure, and compared in both groups.&#x0D; Results: The mean age of the patients was 44.92 ± 6.28 years. Poor outcome was significantly lower in the Laminoforaminotomy group as compared to the Laminectomy group, at 4 weeks after the procedure. The frequency of claudication distance &gt; 500m (good) at 4 weeks was found to be 62 (78.5%) in the Laminectomy group and it was found in 74 (93.7%) patients in the Laminoforaminotomy group (p = 0.022).&#x0D; Conclusions: The study concluded that the laminoforaminotomy is superior to laminectomy, in terms of claudication distance at four weeks after the procedure.

Midterm Outcomes of Muscle-Preserving Posterior Lumbar Decompression via Sagittal Splitting of the Spinous Process: Minimum 5-Year Follow-up.

To overcome several disadvantages of conventional laminectomy for degenerative lumbar spinal stenosis (DLSS), several types of minimally invasive surgery have been developed. The purpose of the present study was to report the clinical and radiological mid-term outcomes of spinous process-splitting decompression (SPSD) for DLSS. Seventy-three consecutive patients underwent SPSD between September 2014 and March 2016. Of these, 42 (70 segments) who had at least 5 years of follow-up were analyzed retrospectively. The visual analog scale for back pain and leg pain, Oswestry disability index, and walking distance without resting were scored to assess clinical outcomes at the preoperative and final follow-up. A subgroup analysis was performed according to the union status of the split spinous processes (SPs). For radiological outcomes, slip in the neutral position as a static parameter, anterior flexion-neutral translation, and posterior extension-neutral translation as a dynamic parameter were measured before and at the final follow-up after surgery. Spinopelvic parameters were also measured. Reoperation rate at the index levels was investigated, and predictive risk factors for reoperation were evaluated using multivariate logistic regression. Survival analysis was performed with reoperation as the endpoint to estimate the longevity of the SPSD for DLSS. All clinical outcomes improved significantly at the final follow-up compared to those at the initial visit (p < 0.05). The clinical outcomes did not differ according to the union status of the split SP. There were no cases of definite segmental instability and no significant changes in the static or dynamic parameters after surgery. Sacral slope and lumbar lordosis increased, and pelvic tilt decreased significantly at the follow-up (p < 0.05), despite no significant change in the sagittal vertical axis. The mean longevity of the procedure before the reoperation was 82.9 months. Five patients (11.9%) underwent reoperation at a mean of 52.2 months after the SPSD. There were no significant risk factors for reoperation; however, the preoperative severity of foraminal stenosis had an odds ratio of 7.556 (p = 0.064). SPSD for DLSS showed favorable clinical and radiological outcomes at the mid-term follow-up. SPSD could be a good surgical option for treating DLSS.

Unilateral microscopic approach for lumbar spinal stenosis decompression: a scoping review.

Microscopic unilateral laminotomy for bilateral decompression (ULBD) is a minimally invasive technique used in the treatment of lumbar spinal stenosis and could limit spinal instability and be associated with better clinical outcomes. However, there is ongoing debate regarding its utility compared to conventional laminectomy (CL). The primary objective was to collate and describe the current evidence base for ULBD, including perioperative parameters, functional outcomes, and complications. The secondary objective was to identify operative techniques. A scoping review was conducted between January 1990 and August 2022 according to the PRISMA extension for scoping reviews (PRISMA-ScR) guidelines. Major databases were searched for full text English articles reporting on outcomes following microscopic unilateral laminotomy in patients with lumbar spinal stenosis. Seventeen articles met the inclusion criteria. Two studies were randomised controlled trials. Two studies were prospective data collection and the rest were retrospective analysis. Three studies compared ULBD with CL. ULBD preserves the osteoligamentous complex and may be associated with shorter operative time, less blood loss, and similar clinical outcomes when compared to CL. This review highlights that ULBD aims to minimise disruption to the normal posterior spinal anatomy and may have acceptable clinical outcomes. It also highlights that it is difficult to draw valid conclusions given there are limited data available as most studies identified were retrospective or did not have a comparator group.

Comparison of posterior decompression techniques and conventional laminectomy for lumbar spinal stenosis.

ObjectivesTo compare the efficacy of posterior decompression techniques with conventional laminectomy for lumbar spinal stenosis.MethodsThe Embase, PubMed, and Cochrane Library databases were searched with no language limitations from inception to January 13, 2022. The main outcomes were functional disability, perceived recovery, leg and back pain, complications. A random effects model was used to pooled data. Risk ratio (RR), mean difference (MD) and 95% confidence interval (CI) were used to report results. The study protocol was published in PROSPERO (CRD42022302218).Results14 trials including 1,106 participants were included in the final analysis. Bilateral laminotomy was significantly more efficacious in improve functionality than laminectomy [MD: −2.94; (95% CI, −4.12 to −1.76)]. Low incidence of iatrogenic instability due to bilateral laminectomy compared with laminectomy [RR: 0.11; (95% CI, 0.02 to 0.59)]. In addition, between those who received bilateral laminotomy and those undergoing laminectomy, the result showed significant difference regarding recovery [RR: 1.31; (95% CI, 1.03 to 1.67)].ConclusionsThis study provides evidence that bilateral laminotomy has advantages in functional recovery, postoperative stability, and postoperative rehabilitation outcomes. Further research is needed to determine whether posterior techniques provide a safe and effective option for conventional laminectomy.

Comparison of spinous process-splitting laminectomy versus posterolateral fusion for lumbar degenerative spondylolisthesis.

Although several studies have recently shown that spinous process-splitting laminectomy (SPSL) maintains lumbar spinal stability by preserving posterior ligament components and paraspinal muscles as compared with conventional laminectomy, evidence is scarce on the treatment outcomes of SPSL limited to lumbar degenerative spondylolisthesis. We herein compare the surgical results and global alignment changes for SPSL versus posterolateral lumbar fusion (PLF) without instrumentation for lumbar degenerative spondylolisthesis. A total of 110 patients with Grade 1 lumbar degenerative spondylolisthesis who had undergone SPSL (47 patients) or PLF (63 patients) with minimum 1-year follow-up were retrospectively enrolled from a single institutional database. Mean operating time per intervertebral level and intraoperative blood loss per intervertebral level were comparable between the SPSL group and PLF group. Japanese Orthopaedic Association scores, Oswestry disability index, and visual analog scale scores were significantly and comparably improved at 1year postoperatively in both groups as compared with preoperative levels. The numbers of vertebrae with slip progression to Grade 2 and slip progression of 5% or more at 1year postoperatively were similar between the groups. In the SPSL group, mean pelvic tilt (PT) was significantly decreased at 1year postoperatively. In the PLF group, mean lumbar lordosis (LL) was significantly increased, while mean sagittal vertical axis, PT, and pelvic incidence-LL were significantly decreased at 1year after surgery. Compared with PLF without instrumentation, SPSL for Grade 1 lumbar degenerative spondylolisthesis displayed comparable results for slip progression and clinical outcomes at 1year postoperatively.

Efficacy of Spinous Process Splitting Decompression Compared with Conventional Laminectomy for Degenerative Lumbar Stenosis

Spinous process splitting decompression (SPSD) is a minimally invasive surgical technique. We evaluated the clinical and radiological outcomes of SPSD compared with conventional laminectomy for the treatment of degenerative lumbar spinal stenosis. SPSD was performed in 144 patients (group 1) and conventional laminectomy was performed in 132 patients (group 2) for degenerative lumbar spinal stenosis. Operative time, blood loss, hospital stay, and complications were compared between groups. Functional outcome was evaluated 2 years after surgery by Oswestry Disability Index, visual analog scale for back pain and leg pain, and progress in walking capacity. Spinal anteroposterior diameter and cross-sectional area were assessed by magnetic resonance imaging and computed tomography. Both groups showed significant improvement in mean functional outcome scores of Oswestry Disability Index and mean visual analog scale for back and leg pain after surgery (P < 0.001), although the differences in scores between the groups (P > 0.05) were not statistically significant. Walking capacity was reported as "much better" and "moderately better" in 89% of patients in group 1 and 87.8% of patients in group 2 (P > 0.05). On the basis of radiographic findings, satisfactory neurological decompression was achieved in group 1 (72.2% increase in mean spinal anteroposterior diameter, 102.5% increase in cross-sectional area) and group 2 (80.3% in mean spinal anteroposterior diameter, 108.8% increase in cross-sectional area) (P > 0.05). Patients who underwent SPSD for lumbar spinal decompression had comparable functional recovery rates correlated with clinical and radiological improvement to patients who underwent conventional laminectomy.

Clinical Evaluation of Surgery for Single-Segment Lumbar Spinal Stenosis: A Systematic Review and Bayesian Network Meta-Analysis.

To compare the efficacy and safety of different surgical procedures for patients with single‐segment lumbar spinal stenosis (LSS), Bayesian network meta‐analysis (NMA) was conducted in this study. Randomized controlled trials (RCTs) which reported 2 years' results after surgery were searched from PubMed, Embase, and Cochrane Register of Controlled Trials up to February 2021. Eligible RCTs that contained at least two of the following surgical procedures, bilateral decompression via the unilateral approach (BDUL), decompression with conventional laminectomy (CL), decompression with fusion (DF), endoscopic decompression (ED), interspinous process devices only (IPDs), decompression with interlaminar stabilization (DILS), decompression with lumbar spinal process‐splitting laminectomy (LSPSL), and minimally invasive tubular decompression (MTD), would be included after screening based on the inclusion and exclusion criteria. The primary outcome was Oswestry Disability Index (ODI). Twenty eligible RCTs were included, with a total of 2201 patients enrolled. The NMA showed that the following surgical procedures ranked first (surface under the cumulative ranking) when compared with CL and DF: DILS for ODI (SUCRA 87.8%); LSPSL for back pain (95%); and MTD for leg pain (95.6%). MTD ranked among the top three surgical procedures for most outcomes. The quality of the synthesized evidence was low according to the Grading of Recommendations Assessment, Development, and Evaluation criteria. DILS, LSPSL, MTD, IPDs, and ED are the most effective procedures for patients with single‐segment LSS. Because of combining efficacy and safety, MTD may be the most promising routine surgical option for treating single‐segment LSS.

Evaluation of the efficacy and safety of conventional and biportal endoscopic decompressive laminectomy in patients with lumbar spinal stenosis (ENDO-B trial): a protocol for a prospective, randomized, assessor-blind, multicenter trial

BackgroundRecent studies on biportal endoscopic spine surgery in patients with lumbar spinal stenosis have reported good clinical results. However, these studies have been limited by the small sample sizes and use of a retrospective study design. Therefore, we aim to compare the efficacy and safety of biportal endoscopic decompressive laminectomy with those of conventional decompressive laminectomy in a multicenter, prospective, randomized controlled trial.MethodsThis study will include 120 patients (60 per group, aged 20–80 years) with 1- or 2-level lumbar spinal stenosis, who will be recruited from six hospitals. The study will be conducted from July 2021 to December 2024. The primary outcome (Oswestry Disability Index at 12 months after surgery) will be evaluated through a modified intention-to-treat method. The secondary outcomes will include the following: visual analog scale score for low back and lower extremity radiating pain, EuroQol 5-dimensions score, surgery satisfaction, walking time, postoperative return to daily life period, postoperative surgical scars, and some surgery-related variables. Radiographic outcomes will be analyzed using magnetic resonance imaging or computed tomography. All outcomes will be evaluated before the surgery and at 2 weeks, 3 months, 6 months, and 12 months postoperatively. This protocol adheres to the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidelines for reporting of clinical trial protocols.DiscussionIt is hypothesized that the efficacy and safety of biportal endoscopic and conventional decompressive laminectomy will be comparable in patients with lumbar spinal stenosis. The results of this trial will provide a high level of evidence for the efficacy and safety of the biportal endoscopic technique in patients with lumbar spinal stenosis and facilitate the development of clinical practice guidelines. Furthermore, the results of this study may indicate the feasibility of the biportal endoscopic technique for other types of spinal surgery.Trial registrationThe ENDO-B trial is registered at Clinical Research Information Service (CRIS, cris.nih.go.kr) (KCT0006057; April 52,021).

Should Posterior Midline Structures Be Preserved in Decompression Surgery for Lumbar Spinal Stenosis?: A Systematic Review and Meta-analysis.

This was a systematic review and meta-analysis study. The purpose of this study is to evaluate the available evidence on the preservation of posterior midline structures in decompression surgery for lumbar spinal stenosis (LSS). The gold-standard treatment for LSS refractory to conservative management is facet-preserving laminectomy. The question remains whether the midline structures should be preserved in decompression surgery for LSS. We performed a systematic review of the Medline, PubMed, Embase, and Cochrane databases in search of published reports comparing midline structure preservation (MSP) and conventional laminectomy (CL) for LSS. The population was divided into 2 groups: (1) MSP group (intervention) and (2) CL group (control). The various outcome parameters including blood loss, operation time, hospital stay, back and leg pain, functional scores including Oswestry Disability Index (ODI) score, Japanese Orthopedic Association score, and 36-Item Short Form Survey (SF-36) scores, satisfaction, and instability rates were analyzed. Data were extracted and aggregated for meta-analysis. Of the published reports, 16 met our inclusion criteria with an aggregated 540 in the intervention and 538 in the control groups, respectively. The aggregated data demonstrated patients undergoing MSP had significantly decreased back pain Visual Analog Scale compared with CL, regardless of time after surgery ( P =0.007). The MSP group also showed a significantly lower Oswestry Disability Index score and SF-36 Mental Component Summary score ( P =0.005 and 0.03, respectively) and longer 6-month walking distance ( P &lt;0.00001). The patient satisfaction rate was significantly higher in the MSP group ( P =0.02), and the instability rate was significantly lower in the MSP group compared with the CL group ( P &lt;0.0001). At 3 days after surgery, MSP significantly decreased the level of creatinine phosphokinase ( P &lt;0.00001). Regarding intraoperative blood loss, hospital stay, leg pain Visual Analog Scale score, Japanese Orthopedic Association score, and SF-36 Physical Component Summary score, there were no significant differences between the 2 groups. However, MSP showed significantly higher operation time ( P =0.04). We concluded despite heterogenous and limited data, this study suggests that preservation of midline structure leads to less severe back pain, better functional recovery, and satisfaction rate. Meanwhile, it decreases creatinine phosphokinase level and instability rate. Level III-therapeutic.

Posterior Floating Laminotomy as a New Decompression Technique for Posterior Cervical Spinal Fusion Surgery.

ObjectiveIn the cervical spine, many surgical procedures have been developed to achieve optimal results for various disorders, including degenerative diseases, traumatic injury, and tumor. In this study, we report our experience and follow-up results with a new surgical technique for cervical spine entitled posterior floating laminotomy (PFL) in comparison with conventional laminectomy and fusion (LF). MethodsData for 85 patients who underwent conventional LF (n=66) or PFL (n=19) for cervical spine disorders between 2012 and 2019 were analyzed. Radiological parameters, including cervical lordosis (CL), T1 slope (T1S), segmental lordosis (SL), and C2–7 sagittal vertical axis (SVA), were measured with lateral spine X-rays. Functional outcomes, comprising the modified Japanese Orthopaedic Association (mJOA), neck disability index (NDI), and visual analog scale (VAS) scores, were also measured. For the patients who underwent PFL, postoperative magnetic resonance image (MRI) was performed in a month after the surgery, and the degree of decompression was evaluated at the T2-weighted axial image, and postoperative computed tomography (CT) was conducted immediately and 1 year after the operation to evaluate the gutter fusion. ResultsThere was no difference in CL, T1S, SL, and C2–7 SVA between the groups but there was a difference in the preoperative and postoperative SL angles. The mean difference in the preoperative SL angle compared with that at the last follow-up was -0.3° after conventional LF and 4.7° after PFL (p=0.04), respectively. mJOA, NDI, and VAS scores showed significant improvements (p<0.05) during follow-up in both groups. In the PFL group, postoperative MRI showed sufficient decompression and postoperative CT revealed gutter fusion at 1 year after the operation. ConclusionPFL is a safe surgical method which can preserve postoperative CL and achieve good clinical outcomes.

P12. Does posterior ligamentous complex disruption following lumbar pedicle screw and rod instrumentation affect the upper adjacent level?

<h3>BACKGROUND CONTEXT</h3> The lumbar level above the fusion segment is the most common level for the development of adjacent level instability. The posterior ligamentous complex (PLC), (eg, interspinous ligament, and supraspinous ligament) a posterior tension band that stabilizes the spine, is usually removed for laminectomy during lumbar fusion and decompression surgery. The removal of the posterior complex may jeopardize upper adjacent level stability. <h3>PURPOSE</h3> To compare mobility and principal disc strains at the upper adjacent level to L4-5 pedicel screw-rod fixation (PSR) between L4-5 PSR, L4-5 PSR+ bilateral laminotomy (PLC preservation), and L4-5 PSR+ conventional laminectomy, in cadaveric specimens. The disc strain was studied with a new optical technique of soft tissue strain analysis (3D digital image correlation (DIC) technique). <h3>STUDY DESIGN/SETTING</h3> Biomechanic testing in human cadaveric spine specimens. <h3>PATIENT SAMPLE</h3> Human cadaveric lumbar spine. <h3>OUTCOME MEASURES</h3> 1. Adjacent segment range of motion, 2. Disc surface strains. <h3>METHODS</h3> Seven human cadaveric L3-S1 specimens were instrumented with L4-5 PSR. All specimens were tested multi-directionally under pure moment loading (7.5Nm) following: 1) L4-5 PSR, 2) L4-5 PSR+bilateral L4 laminotomy while preserving PLC and 3) L4-5 PSR +L4 conventional laminectomy. DIC was performed with cameras positioned laterally (left side) to capture the change in disc principal strain (Pmax and Pmin) at upper adjacent level (L3-4) under peak load. Optical motion tracking was simultaneously performed on the right side. The disc region was divided into four similar sized quarters and included upper and lower endplates. Analysis of variance of upper adjacent level (L3-4) range of motion (ROM) and disc strain between the groups was performed. Statistically significant was set at p≤0.05. <h3>RESULTS</h3> ROM of the upper adjacent (L3-4) level was significantly greater with L4-5 PSR+laminectomy (6.26 degree) versus L4-5 PSR+ bilateral laminotomy (5.94 degree, p=0.006), and L4-5 PSR (5.20 degree, p<0.001) respectively, during flexion. During extension, left lateral bending, and axial rotation, upper adjacent level ROM was significantly greater with L4-5+ laminectomy and L4-5 PSR+ bilateral laminotomy versus L4-5 PSR (p≤0.046) but there were no significant differences between L4-5 PSR+ laminectomy and L4-5PSR+ bilateral laminotomy (p≥0.087). The intervertebral disc Pmax strains of the upper adjacent level were significantly greater with L4-5 PSR+laminectomy than L4-5 PSR during flexion (25,225 VS 18,007uE, p=0.031), extension (22,803 VS 19,356uE, p=0.020), left lateral bending (32,778 VS 24,100uE, p=0.027), right lateral bending (88,761 VS 62,869uE, p=0.024), and right axial rotation (24,747 VS 19,289uE, p=0.025). <h3>CONCLUSIONS</h3> The posterior ligamentous complex disruption during lumbar fusion surgery was associated with significant increases in upper adjacent level instability and principle (Pmax) intervertebral disc stress/strain. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Comparing Mean Post-Operative Back Pain Score between Hemilaminectomy and Conventional Laminectomy in Patients of Lumbar Stenosis

Objective: To observe the comparative mean post-operative back-pain score between hemilaminectomy and conventional laminectomy in patients of lumbar stenosis.&#x0D; Material and Methods: The randomized controlled study was carried out in Neurosurgery Unit, Allied Hospital, Faisalabad, Pakistan. A total of 60 patients were distributed equally in two groups. Group A underwent hemilaminectomy while group B underwent conventional laminectomy. A linear median fascial incision was made on the side with more pain or symptoms. Only in the hemilaminectomy group, ipsilateral decompression was performed. It involves partial resection of adjacent parts of the hemi laminae of the superior and inferior vertebrae using operative loupes or neurosurgical microscope. Mean ±SD was calculated for quantitative data including back pain score.&#x0D; Results: Mean age was 46.2 ± 6.94 years in hemi group and 46.3 ± 6.74 years in the conventional group. We observed that in hemi group, the back pain score was 2.23 ± 0.73 and it was 2.7 ± 0.65 in the conventional group (p-value was 0.011). Significant differences (p value&lt;0.050) existed in these age ranges with respect to the back pain score in both surgery groups. A significant difference (p value &lt; 0.0001) observed only in male patients between two surgery groups for the back pain scores.&#x0D; Conclusion: Mean post-operative back pain score is significantly reduced in hemilaminectomy cases when compared with conventional laminectomy in patients of lumbar stenosis.

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

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.

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

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.